Immune recovery after autologous stem cell transplantation is not different for HIV-infected versus HIV-uninfected patients with relapsed or refractory lymphoma

Cecilia Simonelli, Stefania Zanussi, Chiara Pratesi, Maurizio Rupolo, Renato Talamini, Cristina Caffau, Maria Teresa Bortolin, Rosamaria Tedeschi, Giancarlo Basaglia, Mario Mazzucato, Rosa Manuele, Emanuela Vaccher, Michele Spina, Umberto Tirelli, Mariagrazia Michieli, Paolo De Paoli

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30 Citations (Scopus)

Abstract

Background. High-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT) are feasible and effective salvage treatments for human immunodeficiency virus (HIV)-related relapse or refractory lymphoma. Among the main concerns with ASCT in HIV-infected persons is the additional immune depletion caused by treatment, which could amplify the preexisting immune deficit. The aims of our study were to assess the impact of conventional chemotherapy before salvage treatment was administered, in this population, and to evaluate immune reconstitution dynamics during ASCT. Methods. All 33 HIV-infected and HIV-uninfected patients who underwent comparable ASCT protocols at the National Cancer Institute (Aviano, Italy) who underwent ≥ 1 month of follow-up after transplantation were included in a prospective immunological study. Demographic, clinical, and immunovirological data were obtained before administration of induction therapy, during transplantation, and at 24 months of follow-up. Results. Before HDC, no significant differences were observed in CD4- cell subsets and signal joint T cell receptor excision circles (sjTRECs), although HIV-infected persons had inverted ratios of CD4- cells to CD8+ cells because they had higher CD8+ T cell counts, compared with HIV-uninfected persons. After ASCT, this inversion was also observed in HIV-uninfected patients up to 24 months. CD4+ cell subsets had similar recoveries, with a temporary setback in HIV-infected persons 3 months after reinfusion, together with an increase in infections. sjTRECs demonstrated similar dynamics in both populations and serve as a useful predictive marker of recovery of CD4+ cell subsets. No significant changes emerged in HIV DNA levels during the follow-up period, with values at 24 months significantly lower than those at baseline. Conclusions. Our study demonstrated that ASCT in HIV-infected persons with lymphoma does not worsen the initial immune impairment and does not enhance viral replication or the peripheral HIV reservoir in the long term.

Original languageEnglish
Pages (from-to)1672-1679
Number of pages8
JournalClinical Infectious Diseases
Volume50
Issue number12
DOIs
Publication statusPublished - Jun 15 2010

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Stem Cell Transplantation
Lymphoma
HIV
Salvage Therapy
T-Cell Antigen Receptor
Drug Therapy
Joints
Transplantation
National Cancer Institute (U.S.)
Italy
Population
Cell Count
Demography
Prospective Studies
T-Lymphocytes
Recurrence

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

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Immune recovery after autologous stem cell transplantation is not different for HIV-infected versus HIV-uninfected patients with relapsed or refractory lymphoma. / Simonelli, Cecilia; Zanussi, Stefania; Pratesi, Chiara; Rupolo, Maurizio; Talamini, Renato; Caffau, Cristina; Bortolin, Maria Teresa; Tedeschi, Rosamaria; Basaglia, Giancarlo; Mazzucato, Mario; Manuele, Rosa; Vaccher, Emanuela; Spina, Michele; Tirelli, Umberto; Michieli, Mariagrazia; De Paoli, Paolo.

In: Clinical Infectious Diseases, Vol. 50, No. 12, 15.06.2010, p. 1672-1679.

Research output: Contribution to journalArticle

Simonelli, Cecilia ; Zanussi, Stefania ; Pratesi, Chiara ; Rupolo, Maurizio ; Talamini, Renato ; Caffau, Cristina ; Bortolin, Maria Teresa ; Tedeschi, Rosamaria ; Basaglia, Giancarlo ; Mazzucato, Mario ; Manuele, Rosa ; Vaccher, Emanuela ; Spina, Michele ; Tirelli, Umberto ; Michieli, Mariagrazia ; De Paoli, Paolo. / Immune recovery after autologous stem cell transplantation is not different for HIV-infected versus HIV-uninfected patients with relapsed or refractory lymphoma. In: Clinical Infectious Diseases. 2010 ; Vol. 50, No. 12. pp. 1672-1679.
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abstract = "Background. High-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT) are feasible and effective salvage treatments for human immunodeficiency virus (HIV)-related relapse or refractory lymphoma. Among the main concerns with ASCT in HIV-infected persons is the additional immune depletion caused by treatment, which could amplify the preexisting immune deficit. The aims of our study were to assess the impact of conventional chemotherapy before salvage treatment was administered, in this population, and to evaluate immune reconstitution dynamics during ASCT. Methods. All 33 HIV-infected and HIV-uninfected patients who underwent comparable ASCT protocols at the National Cancer Institute (Aviano, Italy) who underwent ≥ 1 month of follow-up after transplantation were included in a prospective immunological study. Demographic, clinical, and immunovirological data were obtained before administration of induction therapy, during transplantation, and at 24 months of follow-up. Results. Before HDC, no significant differences were observed in CD4- cell subsets and signal joint T cell receptor excision circles (sjTRECs), although HIV-infected persons had inverted ratios of CD4- cells to CD8+ cells because they had higher CD8+ T cell counts, compared with HIV-uninfected persons. After ASCT, this inversion was also observed in HIV-uninfected patients up to 24 months. CD4+ cell subsets had similar recoveries, with a temporary setback in HIV-infected persons 3 months after reinfusion, together with an increase in infections. sjTRECs demonstrated similar dynamics in both populations and serve as a useful predictive marker of recovery of CD4+ cell subsets. No significant changes emerged in HIV DNA levels during the follow-up period, with values at 24 months significantly lower than those at baseline. Conclusions. Our study demonstrated that ASCT in HIV-infected persons with lymphoma does not worsen the initial immune impairment and does not enhance viral replication or the peripheral HIV reservoir in the long term.",
author = "Cecilia Simonelli and Stefania Zanussi and Chiara Pratesi and Maurizio Rupolo and Renato Talamini and Cristina Caffau and Bortolin, {Maria Teresa} and Rosamaria Tedeschi and Giancarlo Basaglia and Mario Mazzucato and Rosa Manuele and Emanuela Vaccher and Michele Spina and Umberto Tirelli and Mariagrazia Michieli and {De Paoli}, Paolo",
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T1 - Immune recovery after autologous stem cell transplantation is not different for HIV-infected versus HIV-uninfected patients with relapsed or refractory lymphoma

AU - Simonelli, Cecilia

AU - Zanussi, Stefania

AU - Pratesi, Chiara

AU - Rupolo, Maurizio

AU - Talamini, Renato

AU - Caffau, Cristina

AU - Bortolin, Maria Teresa

AU - Tedeschi, Rosamaria

AU - Basaglia, Giancarlo

AU - Mazzucato, Mario

AU - Manuele, Rosa

AU - Vaccher, Emanuela

AU - Spina, Michele

AU - Tirelli, Umberto

AU - Michieli, Mariagrazia

AU - De Paoli, Paolo

PY - 2010/6/15

Y1 - 2010/6/15

N2 - Background. High-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT) are feasible and effective salvage treatments for human immunodeficiency virus (HIV)-related relapse or refractory lymphoma. Among the main concerns with ASCT in HIV-infected persons is the additional immune depletion caused by treatment, which could amplify the preexisting immune deficit. The aims of our study were to assess the impact of conventional chemotherapy before salvage treatment was administered, in this population, and to evaluate immune reconstitution dynamics during ASCT. Methods. All 33 HIV-infected and HIV-uninfected patients who underwent comparable ASCT protocols at the National Cancer Institute (Aviano, Italy) who underwent ≥ 1 month of follow-up after transplantation were included in a prospective immunological study. Demographic, clinical, and immunovirological data were obtained before administration of induction therapy, during transplantation, and at 24 months of follow-up. Results. Before HDC, no significant differences were observed in CD4- cell subsets and signal joint T cell receptor excision circles (sjTRECs), although HIV-infected persons had inverted ratios of CD4- cells to CD8+ cells because they had higher CD8+ T cell counts, compared with HIV-uninfected persons. After ASCT, this inversion was also observed in HIV-uninfected patients up to 24 months. CD4+ cell subsets had similar recoveries, with a temporary setback in HIV-infected persons 3 months after reinfusion, together with an increase in infections. sjTRECs demonstrated similar dynamics in both populations and serve as a useful predictive marker of recovery of CD4+ cell subsets. No significant changes emerged in HIV DNA levels during the follow-up period, with values at 24 months significantly lower than those at baseline. Conclusions. Our study demonstrated that ASCT in HIV-infected persons with lymphoma does not worsen the initial immune impairment and does not enhance viral replication or the peripheral HIV reservoir in the long term.

AB - Background. High-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT) are feasible and effective salvage treatments for human immunodeficiency virus (HIV)-related relapse or refractory lymphoma. Among the main concerns with ASCT in HIV-infected persons is the additional immune depletion caused by treatment, which could amplify the preexisting immune deficit. The aims of our study were to assess the impact of conventional chemotherapy before salvage treatment was administered, in this population, and to evaluate immune reconstitution dynamics during ASCT. Methods. All 33 HIV-infected and HIV-uninfected patients who underwent comparable ASCT protocols at the National Cancer Institute (Aviano, Italy) who underwent ≥ 1 month of follow-up after transplantation were included in a prospective immunological study. Demographic, clinical, and immunovirological data were obtained before administration of induction therapy, during transplantation, and at 24 months of follow-up. Results. Before HDC, no significant differences were observed in CD4- cell subsets and signal joint T cell receptor excision circles (sjTRECs), although HIV-infected persons had inverted ratios of CD4- cells to CD8+ cells because they had higher CD8+ T cell counts, compared with HIV-uninfected persons. After ASCT, this inversion was also observed in HIV-uninfected patients up to 24 months. CD4+ cell subsets had similar recoveries, with a temporary setback in HIV-infected persons 3 months after reinfusion, together with an increase in infections. sjTRECs demonstrated similar dynamics in both populations and serve as a useful predictive marker of recovery of CD4+ cell subsets. No significant changes emerged in HIV DNA levels during the follow-up period, with values at 24 months significantly lower than those at baseline. Conclusions. Our study demonstrated that ASCT in HIV-infected persons with lymphoma does not worsen the initial immune impairment and does not enhance viral replication or the peripheral HIV reservoir in the long term.

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