HIV INFECTION IS ASSOCIATED WITH DELAYED PLATELET ENGRAFTMENT AFTER AUTOLOGOUS PERIPHERAL BLOOD STEM CELL TRANSPLANTATION

Abstract

Aim: Hematopoietic Stem Cell Transplantation (HSCT) stands as a cornerstone in the treatment of various disorders. The kinetics of hematopoietic recovery after Autologous Stem Cell Transplantation (ASCT) may be affected by clinical characteristics, including the coexistence of infectious diseases. In 2022, data from the World Health Organization estimated that approximately 39 million people were living with Human Immunodeficiency Virus (HIV) worldwide. The interplay between HIV infection and HSCT outcomes requires better understanding. In this study, we evaluated the association of HIV infection with ASCT outcomes in Minas Gerais, Brazil. Methods: This nested case-control study included individuals with hematological and non-hematological diseases who underwent ASCT. Cryopreservation was conducted at a single processing facility between 2014 and 2023, and patients received clinical care at six transplant centers. Covariates and outcome data were retrieved from participants’ records. HIV-positive participants were compared to age, gender, center, and disease-matched HIV-negative participants (ratio 1:5). Infusion-related adverse effects were recorded using standard forms. Time of engraftment refers to the interval between cell infusion (Day 0) and the first day with a neutrophil count higher than 0.5×109 per L or a platelet count higher than 20×109 per L, respectively. Delayed engraftment was defined as unsuccessful recovery within 14-days after the infusion. Results: Fourteen HIV-positive participants were included. Most of the HIV-positive participants had multiple myeloma (35.7%; n = 5) followed by Hodgkin's lymphoma (28.6%; n = 4), and non-Hodgkin lymphoma (21.4%; n = 3); eleven (78.6%) were male, and the mean age was 47 ± 20 years. As expected, the HIV-positive and HIV-negative groups were similar with respect to the matching variables of age, gender, disease, and transplant center. The median time to platelet engraftment was 14 days for participants with HIV and 11 days for those without HIV (p = 0.017). HIV-positive participants had significantly five times higher odds of delayed platelet engraftment compared to the HIV-negative group (OR = 5.0; 95% CI 1.3–19.9; p = 0.028). The association between HIV infection and time to platelet engraftment, as well as delayed platelet engraftment, remained significant after adjusting for infused CD34+ cell dose (p = 0.008 and p = 0.024, respectively). There was no association between HIV infection and time to neutrophil engraftment or delayed neutrophil engraftment. The frequency of adverse effects during infusion was similar in HIV-positive and HIV-negative participants. Discussion: HIV infection may delay platelet engraftment after ASCT due to immunosuppression, direct effects of HIV on bone marrow cells, chronic inflammation, potential myelosuppressive effects of antiretroviral therapy, co-infections, and pre-existing bone marrow damage. Understanding the dynamics between HIV infection and HSCT outcomes is imperative for optimizing transplant strategies and post-transplant care, including transfusion support. Conclusion: In summary, HIV infection was associated with an increased risk of delayed platelet engraftment in patients undergoing ASCT.