Clinical characteristics and prognosis analysis of autologous hematopoietic stem cell transplantation in 33 patients with HIV-associated lymphoma: A multicenter real-world retrospective study from China (CALL-005 Study)

Abstract In the era of combination antiretroviral therapy (cART), patients with HIV-associated lymphoma (HAL) can tolerate higher-intensity therapies, increasing the feasibility of autologous hematopoietic stem cell transplantation (ASCT). However, data on ASCT for HAL patients remain limited. Methods: We retrospectively analyzed the clinical characteristics and outcomes of 33 HAL patients who underwent ASCT across 7 centers of the CSCO China Immunodeficiency-Related Lymphoma Collaborative Group. This represents the first and largest multicenter study on this topic in China to date. Results: Among the 33 patients, 81.82% received ASCT as first-line consolidation therapy, while 18.18% received it as salvage therapy.All patients successfully mobilized and collected sufficient CD34+ cells with granulocyte colony-stimulating factor (G-CSF). The single-apheresis success rate was higher in the first-line consolidation group (51.9%) compared to the salvage therapy group (33.3%).The median time to neutrophil engraftment was 11 days (range: 8-24 days), and to platelet engraftment was 15 days (range: 8-41 days).The day-100 transplant-related mortality (TRM) was 3% (1/33). The cause of death in this single case (a salvage therapy patient) was disease progression leading to hemophagocytic syndrome.With a median follow-up of 27.04 months (IQR=15.97-51.15 months), 3 patients died due to disease progression. The mortality rate was 33.33% (2/6) in the salvage therapy group and 3.70% (1/27) in the first-line consolidation group.Kaplan-Meier survival analysis demonstrated that patients achieving complete response (CR) pre-transplant had significantly superior median overall survival (OS) compared to those with progressive disease (PD) or partial response (PR): 43 months vs. 14.9 months vs. 13.7 months, respectively (P<0.001).Post-transplant, patients assessed as CR at first evaluation also had significantly better median OS than those with PR: 81 months vs. 26.8 months (P=0.003).Patients with a CD4+ T-cell count ≥200/μL at lymphoma diagnosis had better median OS than those with <200/μL: 44.5 months vs. 19.1 months (P=0.030).In our study, factors including gender, age, pathological subtypes (e.g., DLBCL, BL, PBL), clinical stage, B symptoms, International Prognostic Index (IPI) score, and number of apheresis sessions showed no significant association with patient prognosis (all P>0.05).Multivariate Cox regression analysis, validated by proportional hazards (PH) assumption testing, revealed that achieving only PR pre-transplant was associated with a significantly higher risk of death compared to CR (Hazard Ratio [HR]=15.045, 95% Confidence Interval [CI]: 3.111-72.764, P=0.001). Conclusion: In the cART era, ASCT is highly feasible for patients with HIV-associated lymphoma. Achieving CR followed by ASCT as first-line consolidation therapy may further improve patient prognosis.