The role of allogeneic hematopoietic cell transplantation (alloHCT) in human immunodeficiency virus (HIV)-positive patients is not known. Using the Center for International Blood and Marrow Transplant Research database, we retrospectively evaluated 23 HIV-positive patients undergoing matched sibling donor (n = 19) or unrelated donor (n = 4) alloHCT between 1987 and 2003. The median age at alloHCT was 32 years. Indications for alloHCT were diverse and included malignant (n = 21) and nonmalignant (n = 2) hematologic disorders. Nine patients (39%) underwent transplantation after 1996, the approximate year that highly active antiretroviral therapy became standard treatment. The median time to neutrophil engraftment was 16 days (range, 7 to 30 days), and the cumulative incidences of grade II-IV acute graft-versus-host disease (aGVHD) at 100 days, chronic GVHD (cGVHD), and survival at 2 years were 30% (95% confidence interval [CI] = 14% to 50%), 28% (95% CI = 12% to 48%), and 30% (95% CI = 14% to 50%), respectively. At a median follow-up of 59 months, 6 patients were alive. Survival appears to be better in the patients undergoing alloHCT after 1996; 4 of these 9 patients survived, compared with only 2 of 14 those undergoing transplantation before 1996. These data suggest that alloHCT is feasible for selected HIV-positive patients with malignant and nonmalignant disorders. Prospective studies are needed to evaluate the safety and efficacy of this modality in specific diseases in these patients.
Bibliographical noteFunding Information:
The CIBMTR is supported by Public Health Service Grant U24- CA76518 from the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, and the National Heart, Lung and Blood Institute; the Office of Naval Research; the Health Resources and Services Administration; and grants from AABB, Aetna, American International Group, American Society for Blood and Marrow Transplantation, Amgen, an anonymous donation to the Medical College of Wisconsin; Astellas Pharma US, Baxter International, Bayer HealthCare Pharmaceuticals, BioOne, Blood Center of Wisconsin, Blue Cross and Blue Shield Association, Bone Marrow Foundation, Bristol-Myers Squibb, Cangene, Celgene, CellGenix, Cerus, Cubist Pharmaceuticals, Cylex, CytoTherm, DOR BioPharma, Dynal Biotech, EKR Therapeutics, Enzon Pharmaceuticals, Gambro BCT, Gamida Cell, Genzyme, Gift of Life Bone Marrow Foundation, GlaxoSmithKline, Histogenetics, HKS Medical Information Systems, Hospira, Infectious Diseases Society of America; Kiadis Pharma; Kirin Brewery Co, Merck & Company, Medical College of Wisconsin, MGI Pharma, Millennium Pharmaceuticals, Miller Pharmacal Group, Milliman USA, Miltenyi Biotec, MultiPlan, National Marrow Donor Program, Nature Publishing Group, Oncology Nursing Society, Osiris Therapeutics, Pall Life Sciences, PDL BioPharma, Pfizer, Pharmion, Roche Laboratories, Schering Plough, Society for Healthcare Epidemiology of America, StemCyte, StemSoft Software, SuperGen, Sysmex, Teva Pharmaceutical Industries, The Marrow Foundation, THERAKOS, University of Colorado Cord Blood Bank, ViaCell, Vidacare, ViraCor Laboratories, ViroPharma, and Wellpoint. The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, the Department of the Navy, the Department of Defense, or any other agency of the US Government.
Financial disclosure: This project was supported by funding from the National Marrow Donor Program and the Health Resources and Services Administration (Contracts 240-97-0036 and 231-02-0007, to the National Marrow Donor Program). The views expressed in this article do not reflect the official policy or position of the Health Resources and Services Administration or the National Marrow Donor Program. The authors thank the data managers at the participating transplantation centers, whose diligence in obtaining and reporting the data made this study possible.
- Bone marrow transplantation
- Human immunodeficiency virus