High-dose chemotherapy followed by autologous haemaropoietic stem-cell transplantation is the first-choice salvage treatment for patients with relapsed chemotherapy-sensitive non-Hodgkin lymphoma (NHL).(1) Despite the improvement of immunological status in HIV1-infected patients as a result of new antiretroviral combinations,(2) lymphomas are still seen in this setting. Few patients with HIV-1-associated lymphoma treated with high-dose chemotherapy followed by autologous haematopoietic stem-cell transplantation have been described(3) and the efficacy of such treatment is unknown in terms of the efficiency of stem-cell collection and engraftment, and the impact of intensive therapy on the course of HIV-1 lymphoma and immune repopulation. Between November, 1994, and September, 1999, eight patients (seven men and one woman) received stem-cell transplantation at our institution for refractory or relapsed HIV-1-associated lymphoma. Their baseline clinical and immunological status is summarised in table 1. Median age was 39 years (range 27-53). Four patients had Hodgkin's disease (first relapse in three, second relapse in one), and four patients had NHL (primary refractory in two, first relapse in two). Before transplantation, first-line salvage chemotherapy yielded complete responses in three patients and partial responses in two patients, whereas three patients had resistant disease (table 1). All patients, except one (patient 1) who was grafted in 1994, had received highly-active antiretroviral therapy (HAART) for a median of 24 months (12-30) before stem-cell transplantation; this therapy was maintained during graft collection, transplantation, and after transplantation. The median CD4-cell count before high-dose chemotherapy was 122 cells/mu l and viral load was undetectable in the seven patients receiving HAART (table 2). Bone marrow was harvested from patient 1, and peripheral-blood stem cells were collected from the other seven patients after chemotherapy and treatment with granulocyte colony-stimulating factor. The mean CD34-cell count in the grafts was 7 1.7x10(6)/kg (range 4.5-17.6), and patients had a median of one apheresis session (1-3). Pre-graft conditioning consisted of high-dose chemotherapy alone in three patients and high-dose chemotherapy plus total-body irradiation in the other five patients. Five patients (patients 1, 2, 3, 6, and 7) received granulocyte colony-stimulating factor after stem-cell transplantation for a median of 8 days (7-17). Haematological repopulation could not be assessed in patient 3, who died soon after stem-cell transplantation. In the remaining patients the median time required for granulocyte counts to reach 0.5x10(9)/L was 12 days (9-18) and platelet counts reached 20x10(9)/L after a median of 12 days (9-23). Patient 1 had a low CD4-cell count after stem-cell transplantation (table 2) and died 24 months later from opportunistic infections while in complete remission from lymphoma. We were unable to assess the effect of high-dose chemotherapy on the immune status of the other patients.
