2 Burkitt lymphoma. Note the "starry-sky" appearance with numerous tingible body macrophages. Scattered mitotic fi gures are seen. The cells are medium in size with scant cytoplasm and squared-off cytoplasmic borders (hematoxylin and eosin; 40× original magnifi cation) 

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... overall outcome of HIV-positive patients treated with ASCT seems compa- rable to their HIV-negative counterparts. Indeed, two studies have specifi cally addressed this issue, a European registry-based multicenter study and a single- institution matched case-control study at City of Hope, USA [ 30 , 31 ]. In the former study, a comparative analysis between HIV-related lymphoma and matched cohort of HIV-negative lymphoma patients, OS and PFS were not statistically different in both cohorts. The main cause of death was disease relapse or progression in both groups. The cumulative incidence of relapse was not signifi cantly different (29 % for HIV positive and 42 % for HIV negative), although there was a more favorable trend in the HIV-positive group ( P = NS) [ 30 ]. The latter study compared long-term results of 29 HIV-positive patients with 29 matched pair HIV-negative patients treated identically in the same center. In this series, the OS was the same in both cohorts (75 % at 2 years). Despite inclusion of more poor-risk HIV-positive NHL patients, a trend towards better 2-year disease-free survival was registered in HIV- positive patients (76 %) compared to HIV negative (56 %) ( P = 0.3) ( Fig. 12.2 ). The only factor predictive of outcome was disease status at transplant [ 31 ...

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... preparative regimens have been used as salvage/debulking treatment before HDT (mainly platinum-containing regimens) and as conditioning preparation to ASCT (mainly BEAM: BCNU, etoposide, cytarabine, melphalan). No superiority has been demonstrated of one regimen over another even in the HIV-negative popula- tion. The results of the main series reported in literature are shown in Table 12.1 [ 12 , 13 , 20 -24 ]. These studies showed that transplant-related mortality rates were low and that durable remissions could be obtained. After variable follow-up periods, progression-free survival (PFS) varied from 29 to 85 % and overall survival (OS) from 36 to 87 %, with excellent results in those studies that included patients in fi rst complete remission (variously defi ned at "high risk"), in partial remission, and in fi rst relapse [ 13 , 24 ], while the outcome was less satisfactory in series that included patients with primary refractory and salvage-resistant disease [ 20 ]. Hence, the effi - cacy of ASCT in HIV-related lymphoma depends on the status of disease at the time of transplantation, as is the case in HIV-negative patients. The best results are achieved in patients who have minimal disease before the transplant, as reported in a multicenter trial from 20 centers in Europe. In this study, that enrolled 68 patients, a subgroup analysis found that patients not in complete remission or with refractory disease at the time of transplant had a poorer progression-free survival [ 12 ]. However, the reported studies on ASCT in HIV-positive patients were mainly retrospective [ 12 , 20 ] or recruited patients at the time of stem cell collection [ 11 , 13 , 22 , 24 ], thus ren- dering it diffi cult to understand the real impact of the procedure on the whole popula- tion of relapsing/refractory patients who need salvage. Instead, in the Italian study [ 21 ], patients were recruited at the time of treatment failure or relapse; 54 % of the entire series of 50 patients were able to proceed to ASCT, a percentage comparable to the HIV-negative population, with satisfactory results in patients receiving trans- plantation (overall survival 74.6 %) as well as in the entire series, with 49.8 % of patients alive after a median follow-up of 45 months (9-86 months) (Fig. 12.1 ...

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... in plasmablastic lymphoma in the HIV-positive setting appear promising [ 26 ] in both upfront treatment and for relapsed patients. However, NHL histologies other than diffuse large B-cell lymphoma proved to be an adverse prognostic factor on multivariate analysis in a European multicenter series [ 12 ]. Furthermore, Burkitt lymphoma is currently treated with specifi c intensive treatment programs without ASCT, both in the HIV-positive and in the HIV-negative population, and the role of ASCT remains unclear. Future studies evaluating ASCT should be designed for specifi c histologic entities. Larger studies would also provide more insight into vari- ous parameters that may play an important role in infl uencing outcome, such as type of cART, CD4 cell count, HIV-viral load before ASCT, EBV status, and tumor histogenesis. Fig. 12.1 ( a ) Overall survival and progression-free survival of 27 patients with HIV-related lym- phoma after ASCT (Ref. [ 21 ]). ( b ) Overall survival and progression-free survival of the entire series of 50 patients with HIV-related lymphoma eligible for the study (Ref. [ 21 ...