Autologous Stem Cell Transplant for HIV-Associated Lymphoma: A Systematic Review and Meta-Analysis

Area of Science:

• Hematology
• Oncology
• Infectious Diseases

Background:

• HIV-associated lymphoma (HAL) remains a significant cause of mortality despite advancements in antiretroviral therapy.
• Autologous stem cell transplant (ASCT) offers a potential cure for relapsed/refractory (R/R) HAL but faces challenges due to HIV-related immunosuppression.

Purpose of the Study:

• To systematically review prospective evidence on the efficacy and toxicity of ASCT in patients with HIV-associated lymphoma.
• To evaluate the outcomes of ASCT in the context of HIV-related immunosuppression.

Main Methods:

• A systematic review of prospective studies was conducted using PubMed, Cochrane, Embase, and ClinicalTrials.gov.
• Studies published between January 1996 and June 2026 were included, with exclusions for non-English, retrospective, small-cohort, and primary CNS lymphoma studies.
• Efficacy analysis excluded first-line ASCT, while toxicity analysis included it. Data were analyzed using MedCalc v22.032.

Main Results:

• Six non-randomized prospective studies with 134 patients (33 Hodgkin lymphoma, 101 non-Hodgkin lymphoma) were identified.
• The pooled six-month non-relapse mortality (NRM) was 5.39%.
• For relapsed/refractory HAL patients, estimated 2-year overall survival (OS) was 79.8% and progression-free survival (PFS) was 77.9%.

Conclusions:

• ASCT for HAL demonstrates non-relapse mortality rates comparable to historical data in non-HIV populations.
• Encouraging overall survival and progression-free survival rates were observed, though prospective data remain limited.
• Absence of comparative data highlights the need for further research and clinical trials.