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Hematopoietic stem cell transplantation safe in patients with HIV
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An analysis of hematopoietic stem cell transplant recipients in the United States over a 14-year period showed that patients with HIV do not have an increased risk for serious in-hospital complications despite having a potentially higher risk for certain opportunistic infections.
Research has demonstrated that patients with HIV are living longer because of the availability of highly active ART. This has led to an increase in the incidence of HIV-associated malignancies as well as hematopoietic stem cell transplantation (HSCT) to treat these malignancies, according to Kathan Mehta, MBBS, MPH, resident physician in the division of hematology-oncology at the University of Pittsburgh Medical Center, and colleagues.
Although previous studies have shown that HSCT outcomes are similar between HIV-positive and HIV-negative patients, Mehta and colleagues noted that these studies are limited by their small sample sizes and lack of recent data. Therefore, the researchers assessed the outcomes of 39,517 patients who underwent allogeneic or autologous HSCT from 1998 to 2012 to better understand the risks associated with HSCT among patients with HIV. The primary outcome was the rate of in-hospital mortality among HIV-positive and HIV-negative patients.
According to the data, the number of patients with HIV undergoing HSCT in the U.S. has continuously increased from 81 patients between 1998 and 2002 to 278 patients between 2008 and 2012.
For allogeneic HSCT, patients with HIV were more likely to have nontuberculous mycobacteria (5.4% vs. 0.2%; P < .0001) and cytomegalovirus infection (22.2% vs. 6.3%; P = .04) than patients without HIV. However, there was no significant difference in the incidence of intubation (6.1% vs. 8.2%), sepsis (28.8% vs. 13.1%), bacteremia (40.2% vs. 23.3%), graft-versus-host disease (22.9% vs. 17.9%), total parenteral nutrition (TPN) use (11.8% vs. 23.4%) and venous thromboembolism (VTE; 11% vs. 4.5%).
Similarly, for autologous HSCT, there was no significant difference between groups for intubation (3.1% vs. 2.5%), sepsis (6.3% vs. 8.1%), bacteremia (10.7% vs. 16%), TPN use (9% vs. 13.1%) and VTE (2% vs. 3.7%).
In a multivariate analysis, there was no significant difference in inpatient mortality between the groups for both allogeneic (OR = 1.27; 95% CI, 0.44-3.66) and autologous (OR = 0.95; 95% CI, 0.26-3.49) HSCT.
“In summary, frequency of HSCT is increasing in HIV-positive patients with underlying indication for HSCT,” the researchers concluded. “Allogeneic and autologous HSCT can be safely performed in HIV-positive patients.” – by Stephanie Viguers
Disclosures: The authors report no relevant financial disclosures.
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