Autologous Stem Cell Transplantation Of HIV-Positive Plasmablastic Lymphoma - Case Series

Plasmablastic lymphoma (PBL) is an aggressive B-cell non-Hodgkin lymphoma (NHL) commonly associated with immunosuppressed conditions, such as HIV infection. Historically, HIV-positive patients were not considered candidates for aggressive systemic therapies due to the risk of life-threatening opportunistic infections. However, with the advent of highly active antiretroviral therapy (HAART), the management of HIV-associated lymphomas has improved, allowing for more intensive treatments, including autologous stem cell transplantation (ASCT). This case series explores the safety and efficacy of ASCT in HIV-positive patients with PBL as consolidation at first complete response (CR1) following first-line chemotherapy. Patients who underwent ASCT for PBL at CR1 after first-line chemotherapy were selected from the Bone Marrow Transplant (BMT) registry from January 2015 to December 2024. Clinical details, transplant specific details and outcomes were collected from the case records. Three cases of HIV-positive patients diagnosed with PBL underwent ASCT as consolidation therapy were included in the case series. ASCT was done after achieving complete metabolic response (CMR) following induction chemotherapy. All patients received dose-adjusted EPOCH chemotherapy along with HAART. HAART was temporarily withheld during conditioning chemotherapy. Prophylactic medications were administered to prevent infections. Complications during the peri-transplant period included febrile neutropenia and mucositis, but no opportunistic infections were reported. CD4 counts dropped during the transplant period but stabilized post-transplant, with no significant long-term decline. ASCT is a safe and effective treatment option for HIV-positive patients with PBL who achieve CMR after induction chemotherapy. The procedure is well-tolerated, with manageable complications and favourable long-term outcomes. ASCT should be considered as a consolidation therapy for eligible HIV-positive patients with PBL, offering the potential for prolonged disease-free survival.