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Allogeneic stem cell transplantation in HIV-1 infected patients with high-risk hematological disorders.

INTRODUCTION
Although a number of patients with HIV infection and hematological disease have successfully undergone allogeneic hematopoietic stem cell transplantation (HSCT), short and long-term outcomes remain not well known. We report the largest Spanish experience treating HIV-infected adult patients with high-risk hematological malignancies with allogeneic HSCT.


METHODS
We retrospectively reviewed 22 HIV-positive patients who received allogeneic HSCT in 5 centers in Spain.


RESULTS
22 patients with high-risk hematological malignancies were transplanted between 1999 and 2018. Median age was 44 years. With a median follow-up of 65 months (8-112), OS and EFS were 46%. NRM was 14% at 12 months and relapse was 24% at 24 months. Grade II-IV aGvHD rate was 40%, and moderate/severe cGvHD rate was 41% at 24 months. All patients received cART. Two patients showed severe toxicity related to drug interaction with anti-retroviral therapy. 68% of patients showed infectious complications with viral infections as the most frequent cause. Two patients had invasive aspergillosis and one patient presented disseminated tuberculosis. All survivors except one maintained undetectable HIV load at last follow-up after HSCT.


CONCLUSIONS
Allogeneic HSCT is an effective therapy for high-risk hematological malignancies in patients with HIV infection, and long-term HIV suppression with cART is feasible. However, drug interactions with anti-retroviral agents, occurrence of GVHD, and frequent infectious complications account for a complex procedure in this population. Selected HIV-infected patients with hematologic malignancies should be considered for allo-HSCT when indicated, in experienced centers.