Differences in Hematopoietic Cell Transplantation Outcomes by HIV status, California, 1991-2016

Hematopoietic cell transplantation (HCT) can be curative for lymphoma, yet population-level HCT outcomes by HIV status are not well studied, contributing to variable access to HCT for people with HIV.

The purpose of this study is to evaluate if there are differences in clinical outcomes, hospital utilization, and overall survival following HCT between the cohorts.

In this population-based study, we used data from a linkage between California Cancer Registry, Center for International Blood and Marrow Transplant Research, and the California Patient Discharge Database to identify HCT recipients between 18-79 with first primary lymphoma between 1991-2016. HIV and non-HIV cohorts matched 1:3 on age, sex, lymphoma subtype, stage at diagnosis, HCT type, year of transplant +3 years, and time from diagnosis to transplant +2 years resulted in 140 HIV and 409 non-HIV (N=549) patients. Clinical outcomes (acute renal and liver complications), hospital utilization (number of admissions and total length of stay), and overall survival were compared between the matched cohorts using adjusted cox proportional hazards regression models.

Between HIV and non-HIV cohorts, there were no significant differences in 90-day acute complications or hospital use (acute renal complications hazard ratio (HR)=1.05, 95% confidence interval (CI): 0.66-1.69; acute liver complications HR=0.69, CI: 0.09-5.04; sepsis HR=1.15, CI: 0.48-2.79; infection HR=0.92, CI: 0.56-1.52; any admission HR=0.92, CI: 0.71-1.20). Overall survival at 90 days (94% HIV vs 93% non-HIV), 1 year (78% HIV vs 73% non-HIV) and 2 years (73% HIV and 69% non-HIV) following HCT was similar between groups (p=0.33).

Our findings suggest that HIV status does not confer higher risk of acute complications, greater risk of hospital utilization, or lower overall survival, contributing to the evidence that HCT can be safely and equitably used in people with HIV that are otherwise eligible.