Efficacy of Autologous Stem Cell Transplantation for the Treatment of Multiple Myeloma in HIV-Positive Patients
Prior to the advent of anti-retroviral therapy (ART), autologous stem cell transplant (ASCT) was relatively contraindicated for multiple myeloma (MM) patients with human immunodeficiency virus (HIV) due to issues associated with stem cell harvest and the risk of opportunistic infections. With the widespread use of ART for control of HIV, ASCT is now the preferred treatment for relapsed lymphoma, the leading hematopoietic malignancy associated with HIV/AIDS. Hence, MM patients with HIV controlled by ART may benefit equally from aggressive combination treatment of chemotherapy and ASCT. This study seeks to evaluate the clinical course and treatment outcomes of patients with HIV and MM treated with ASCT. Five male patients with average age 53.2 years were included in this study. Patients were diagnosed with HIV prior to diagnosis of MM and were appropriately treated with ART prior to ASCT. All patients had undetectable HIV viral load (VL) prior to ASCT, and remained undetectable after ASCT. Adequate CD34+ stem cells were collected. Patients received high dose melphalan (200 mg/m2) followed by ASCT. ART was continued during ASCT. Patients experienced usual ASCT toxicities including diarrhea, mucositis, and neutropenic fever. All patients had normal neutrophil and platelet engraftments. 60% of patients had very good partial response or better after ASCT. All patients received post ASCT maintenance until progression/toxicity/patient decision. As of December 2020, 2 patients have died 51 and 85 months from ASCT due to other causes. The 3 remaining patients are alive 5-7 years after ASCT. MM patients with concurrent HIV infection that is controlled on ART would benefit from aggressive treatment with chemotherapy and ASCT, with continued ART as they tolerate ASCT as well as myeloma patients without HIV infection.
