Differences in Hematopoietic Cell Transplantation Outcomes by Human Immunodeficiency Virus Status, California, 1991...

Hematopoietic cell transplantation (HCT) can be curative for lymphoma, yet population-level HCT outcomes by human immunodeficiency virus (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 and 79 with first primary lymphoma between 1991 and 2016. HIV and non-HIV cohorts matched 1:3 on age, sex, lymphoma subtype, stage at diagnosis, HCT type, year of transplant +3 yr, and time from diagnosis to transplant +2 yr 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-d acute complications or hospital use (acute renal complications hazard ratio [HR] = 1.05, 95% confidence interval [CI]: 0.66 to 1.69; acute liver complications HR = 0.69, CI: 0.09 to 5.04; sepsis HR = 1.15, CI: 0.48 to 2.79; infection HR = 0.92, CI: 0.56 to 1.52; any admission HR = 0.92, CI: 0.71 to 1.20). Overall survival at 90 d (94% HIV versus 93% non-HIV), 1 yr (78% HIV versus 73% non-HIV) and 2 yr (73% HIV and 69% non-HIV) following HCT was similar between groups (P = .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.