Hematopoietic stem cell transplantation for AIDS-related malignancies

AIDS-related malignancies are an ongoing cause of mortality in individuals with HIV infection. In the HIV-negative setting, high-dose chemotherapy or stem cell transplantation is an option for patients with hematologic malignancies. Prior to the advent of effective HIV therapy, stem cell transplantation was not feasible for HIV-positive patients. The purpose of this article is to explore the transplant options for HIV-positive patients after widespread use of highly active antiretroviral therapy.

Early autologous stem cell transplantation has studies had high relapse rates but they demonstrated that mobilization and engraftment of autologous stem cells were possible in AIDS patients. Recently, in less advanced AIDS lymphoma, autologous stem cell transplantation has resulted in low transplant-related mortality and durable remissions. In addition, case-control studies of HIV-positive versus HIV-negative lymphoma patients undergoing autologous stem cell transplantation have shown similar transplant-related mortality and overall survival. The feasibility of allogeneic stem cell transplantation in HIV-infected individuals is less tested. There are challenges of drug interactions between highly active antiretroviral therapy and immunosuppressive agents as well as the potential for higher infection rates.

The potential future applications of autologous and allogeneic stem cell transplantation are the cure of the malignancy as well as the underlying HIV infection by either transplantation of naturally resistant or genetically modified stem cells.