# Autologous Stem Cell Transplantation in HIV-Positive and HIV-Negative Patients with Lymphoma: A Propensity Score-Matched Comparative Analysis

## TL;DR

This study shows that autologous stem cell transplantation is more effective for HIV-positive lymphoma patients compared to HIV-negative patients, with better survival and lower relapse rates.

## Contribution

The study is the first to demonstrate better progression-free survival and lower relapse rates in HIV-positive patients after stem cell transplantation compared to HIV-negative patients.

## Key findings

- HIV-positive patients had significantly higher 4-year progression-free survival (81%) compared to HIV-negative patients (51%).
- Relapse rates were significantly lower in HIV-positive patients (23%) compared to HIV-negative patients (36%).
- Four-year overall survival was 81% in HIV-positive and 67% in HIV-negative patients, though not statistically significant.

## Abstract

Treatment of HIV-associated lymphoma (HIV-Ly) with autologous stem cell transplantation (ASCT) has shown to be feasible and effective. In this study we compare the clinical outcomes of HIV-Ly and lymphomas of the general population receiving ASCT, analyzing two series of consecutive HIV-positive and HIV-negative patients, based on a 1:1 propensity score match analysis. Forty-four patients were identified in both groups. Progression-free survival (PFS), defined as the time from ASCT to relapse, progression or death for any cause, was significantly higher in HIV-positive patients (4-year PFS 81% and 51%, in HIV-positive and HIV-negative patients, respectively, p = 0.027). The 4-year OS was 81% in HIV-positive and 67% in HIV-negative patients (p = 0.15). The relapse rate was significantly higher in HIV-negative patients (36% vs. 23%) (p = 0.04). Our results increase the awareness of ASCT as an effective curative option for HIV-Ly and show for the first time better PFS and a low relapse rate after ASCT in patients with HIV compared to patients without, in a statistically reliable manner.

Background/Objectives: Treatment of HIV-associated lymphoma (HIV-Ly) with autologous stem cell transplantation (ASCT) has shown a surprisingly low relapse rate in several series. The aim of this study was to compare the clinical outcomes of HIV-Ly and lymphomas in the general population receiving ASCT. Methods: We compared two series of consecutive HIV-positive and HIV-negative patients, based on a 1:1 propensity score analysis, matching for age, sex, histology, disease status and prior therapies. Results: After propensity matching we identified a final population of 88 patients (44 HIV-positive vs. 44 HIV-negative). All HIV-positive patients received combination antiretroviral therapy (cART). With a median follow-up of 51 months, PFS was significantly higher in HIV-positive patients (4-year PFS 81% and 51%, in HIV-positive and HIV-negative patients, respectively, p = 0.027). Four-year OS was 81% for HIV-positive and 67% in HIV-negative patients (p = 0.15). The relapse rate was significantly higher in HIV-negative patients (36% vs. 23%) (p = 0.04). Conclusions: Our results clearly show that ASCT is an effective curative option for HIV-Ly, with better PFS and a lower relapse rate compared to patients without HIV. A favorable effect of ASCT on HIV infection and immune system recovery, potential off-target effects of cART or other yet unknown factors may account for this observation.