HIV-positive patients with hematologic malignancies are frequently not considered for treatment with allogeneic hematopoietic stem cell transplantation (alloHSCT) because of reported high morbidity and mortality with this procedure and scant published experience. Advances in HIV care and supportive care for alloHSCT prompted us to review our experience since 2010, after we instituted multidisciplinary management of HIV-infected patients during the peri-transplant period.
We retrospectively reviewed the records of all HIV-positive patients who received alloHSCT at our institution since 2010.
Five patients with various hematologic malignancies received alloHSCT from matched related (2) or unrelated (3) donors since 2010. All patients received tenofovir/emtricitabine in combination with either efavirenz (1) or raltegravir (4) and engrafted a median of 17 days post-transplant. The most common infection was CMV viremia, 6 episodes in 4 patients, controlled with antivirals. There was no transplant-related mortality. Three patients relapsed 6, 7 and 13 months post-transplant, two were alive and well after 42 and 55 months. HIV viral load remained undetectable and CD4+ cell count increased progressively. One patient had acute renal failure and improved with hydration and replacement of tenofovir with abacavir.
Our patients received alloHSCT without transplant-related mortality or major infectious complications. Their HIV viral load remained undetectable without the use of protease inhibitors or need to discontinue antiretroviral therapy. One patient had acute renal failure that resolved after discontinuation of tenofovir. Our findings support considering selected HIV-infected patients for alloHSCT when indicated for the management of their hematologic malignancies.