Successful autologous stem cell transplant with LACE-chemotherapy on the background of human immunodeficiency virus

Abstract

Aim: To describe a case of autologous stem cell transplantation (ASCT) and successful engraftment in a human immunodeficiency virus (HIV) patient with lymphoma while continuing anti-retroviral treatment (ART). Clinical Case: A 55-year-old man was admitted for LACE (lomustine, etoposide, cytarabine and cyclophosphamide) ASCT for anaplastic large cell non-Hodgkin lymphoma, initially treated with CHO(E)P (cyclophosphamide, doxorubicin, vincristine, etoposide, prednisolone) chemotherapy. Medical history included HIV (CD4 count 329 cells per/μL and suppressed viral load for last 10 years) and doxorubicin-induced cardiotoxicity. After a complete remission demonstrated on positron emission tomography (PET) scan and bone marrow biopsy, it was decided to proceed to ASCT to consolidate treatment. Pre-existing regimen of raltegravir and emtricitabine/tenofovir was continued and full dose conditioning regimen LACE was utilised. Post-ASCT complications included culture positive Enterobacter and Enterococcal neutropenic hypotensive septicaemia and Clostridium difficile diarrhoea. After a nadir of 0.0 × 109/L, neutrophils recovered to 0.86 × 109/L on day 16. Outcome: Engraftment was successful, with neutrophils at >1.0 × 109/L and all complications had resolved by day 30 post-transplant. At 6 months follow-up, CD4 count dropped to 201.6 cells per/μL and viral load remained stable. Conclusion: ASCT, with full-dose conditioning, can be performed while ART therapy continues, with no adverse impact on engraftment or HIV control.