High-dose therapy and autologous peripheral-blood stem-cell transplantation as salvage treatment for HIV-associated lymphoma in patients receiving highly active antiretroviral therapy
High-dose therapy and autologous peripheral-blood stem-cell transplantation as salvage treatment for HIV-associated lymphoma in patients receiving highly active antiretroviral therapy
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DOI：
10.1200/jco.2003.06.039
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发表时间：
2003-12-01
影响因子：
45.3
通讯作者：
Rossi, G
中科院分区：
文献类型：
--
作者：
Re, A;Cattaneo, C;Rossi, G
目的：最近，在选定的患者中报告了HIV相关淋巴瘤（HIV-Ly）的高剂量治疗（HDT）和外周血干细胞移植（PBSCT）。我们描述了一个多机构的HDT和PBSCT作为挽救治疗的结果在HIV-Ly响应高效抗逆转录病毒疗法（HAART）在cardiovascular patients.Patients和方法：一线化疗（CT）后耐药或复发的HIV-Ly患者进行PBSC收集后，第二线CT或环磷酰胺和粒细胞集落刺激因子的过程。化疗敏感性疾病患者接受卡莫司汀、依托泊苷、阿糖胞苷和美法仑（BEAM方案）和PBSC回输。有效的HAART维持在整个program.Results：连续16例患者进入该计划。在80%的患者中获得了足够的PBSC（中位CD 34（+）细胞6.8 x 10（6）/kg）。3例患者出现早期进展。10例患者（62%）接受了PBSCT，所有患者均迅速植入（中性粒细胞和血小板分别在中位10天[范围，8 - 10天]和13天[范围，8 - 18天]后植入）。无患者死于机会性感染或其他感染或治疗相关并发症。9例可评估患者中有8例达到完全缓解（1例患者因残留疾病接受放疗后），1例患者达到部分缓解。2例患者复发，并在+10和+14个月时死亡。6例患者存活和无病中位值为8个月后transplantation.Conclusion：我们的数据证实，HDT加PBSCT是可行的，积极作为挽救治疗HIV-Ly在多机构的基础上，并在HAART反应的患者。HIV感染不应再排除淋巴瘤患者发生HDT的机会。(C)2003年，美国临床肿瘤学会。
Purpose: High-dose therapy (HDT) and peripheral-blood stem-cell transplantation (PBSCT) in HIV-associated lymphoma (HIV-Ly) has been recently reported in selected patients. We describe the results of a multi-institutional program of HDT and PBSCT as salvage therapy in HIV-Ly responsive to highly active antiretroviral therapy (HAART) in unselected patients.Patients and Methods: Patients with resistant or relapsed HIV-Ly after first-line chemotherapy (CT) underwent PBSC collection after a course of second-line CT or cyclophosphamide and granulocyte colony-stimulating factor. Patients with chemotherapy-sensitive disease received carmustine, etoposide, cytarabine, and melphalan (BEAM regimen) and PBSC reinfusion. Effective HAART was maintained during the entire program.Results: Sixteen consecutive patients entered the program. Adequate collection of PBSC was obtained in 80% of patients (median CD34(+) cells 6.8 x 10(6)/kg). Three patients had early progression. Ten patients (62%) received PBSCT with prompt engraftment in all patients (neutrophils and platelet engraftment after a median of 10 days [range, 8 to 10 days] and 13 days [range, 8 to 18 days], respectively). No patients died as a result of opportunistic or other infections or treatment-related complications. Eight of nine assessable patients achieved complete remission (one patient after radiotherapy for residual disease) and one patient achieved partial remission. Two patients experienced relapse and died at +10 and +14 months. Six patients are alive and disease free at a median of 8 months after transplantation.Conclusion: Our data confirm that HDT plus PBSCT is feasible and active as salvage therapy in HIV-Ly on a multi-institutional basis and in unselected HAART-responding patients. HIV infection should no longer preclude the opportunity of HDT in patients with lymphoma. (C) 2003 by American Society of Clinical Oncology.