Safety of Autologous Stem Cell Transplantation in Patients with Known HTLV-1 Infection: A Case Series of 4 Patients

Human T-cell lymphotrophic virus types 1 and 2 (HTLV-1/2) are delta retroviruses endemic to the Caribbean and Japan (Gessain et al., 2013). They are known to cause adult T-cell lymphoma-leukemia (ATLL) and tropical spastic paraparesis/HTLV-1 associated myelopathy (HAM) (Mahieux et al., 2003). Given the link between immunosuppressive states and development of lymphoproliferative disorders, there is hesitation on the behalf of clinicians to offer stem cell transplantation to patients who test positive for HTLV-1/2 antibody. We reviewed four cases of patients who underwent autologous stem cell transplantation (ASCT) at our institution after having tested positive for HTLV-1/2 antibody (Table 1). The median patient age at the time of ASCT was 58 years (range, 51-60). Two patients tested positive for HTLV-1 antibody and two tested positive for HTLV-2 antibody. Two patients underwent ASCT for treatment of multiple myeloma, one for diffuse large B-cell lymphoma (DLBCL), and one for light chain amyloidosis (AL). The myeloma patients received standard induction therapy with cyclophosphamide, bortezomib, and dexamethasone (CyBorD) or lenalidomide, bortezomib, and dexamethasone (RVD). The DLBCL patient received rituximab, ifosfamide, carboplatin, and etoposide (R-ICE), while the AL patient underwent ASCT without induction. Three patients underwent conditioning with high-dose melphalan (200 mg/m²; HDM) and the lymphoma patient received carmustine, cyclophosphamide, and etoposide (BCV). Median stem cell collection was 8.35 x 10⁶ CD34+ cells per kg (range, 4.8 -30.7). The median follow-up for these patients from date of transplantation was 22.4 months (range, 7.3-38.6). Median time to neutrophil and platelet engraftment was 9.5 days (range, 8-10) and 10 days (range, 9-14) respectively. Among these four patients, none developed complications related to HTLV-1/2 infection during the follow-up period. Two patients had a post-transplant course complicated by febrile neutropenia, and one patient developed typhlitis. One patient died on day + 221 due to a recurrence of cholangiocarcinoma leading to liver failure, and the other three remained alive at the time of last follow-up. Our data provides support that testing positive for HTLV-1/2 does not preclude eligibility for ASCT.

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