γ-Herpesvirus load as surrogate marker of early death in HIV-1 lymphoma patients submitted to high dose chemotherapy and autologous peripheral blood stem cell transplantation

PLoS One. 2015 Feb 10;10(2):e0116887. doi: 10.1371/journal.pone.0116887. eCollection 2015.

Abstract

Autologous stem cell transplantation (ASCT) is a feasible procedure for human immunodeficiency virus-1 (HIV-1) lymphoma patients, whose underlying disease and intrinsic HIV-1- and ASCT-associated immunodeficiency might increase the risk for γ-herpesvirus load persistence and/or reactivation. We evaluated this hypothesis by investigating the levels of Epstein-Barr virus (EBV)- and Kaposi sarcoma-associated herpesvirus (KSHV)-DNA levels in the peripheral blood of 22 HIV-1-associated lymphoma patients during ASCT, highlighting their relationship with γ-herpesvirus lymphoma status, immunological parameters, and clinical events. EBV-DNA was detected in the pre-treatment plasma and peripheral blood mononuclear cells (PBMCs) of 12 (median 12,135 copies/mL) and 18 patients (median 417 copies/10(6) PBMCs), respectively; the values in the two compartments were correlated (r = 0.77, p = 0.0001). Only EBV-positive lymphomas showed detectable levels of plasma EBV-DNA. After debulking chemotherapy, plasma EBV-DNA was associated with lymphoma chemosensitivity (p = 0.03) and a significant higher mortality risk by multivariate Cox analysis adjusted for EBV-lymphoma status (HR, 10.46, 95% CI, 1.11-98.32, p = 0.04). After infusion, EBV-DNA was detectable in five EBV-positive lymphoma patients who died within six months. KSHV-DNA load was positive in only one patient, who died from primary effusion lymphoma. Fluctuations in levels of KSHV-DNA reflected the patient's therapy and evolution of his underlying lymphoma. Other γ-herpesvirus-associated malignancies, such as multicentric Castleman disease and Kaposi sarcoma, or end-organ complications after salvage treatment were not found. Overall, these findings suggest a prognostic and predictive value of EBV-DNA and KSHV-DNA, the monitoring of which could be a simple, complementary tool for the management of γ-herpesvirus-positive lymphomas in HIV-1 patients submitted to ASCT.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents / therapeutic use
  • Biomarkers / metabolism
  • Death
  • Female
  • Gammaherpesvirinae / metabolism*
  • HIV-1 / metabolism
  • Humans
  • Lymphoma, AIDS-Related / diagnosis*
  • Lymphoma, AIDS-Related / metabolism
  • Lymphoma, AIDS-Related / therapy*
  • Lymphoma, AIDS-Related / virology
  • Male
  • Middle Aged
  • Peripheral Blood Stem Cell Transplantation / methods
  • Prognosis
  • Retrospective Studies
  • Transplantation, Autologous / methods
  • Tumor Virus Infections / metabolism*
  • Viral Load*

Substances

  • Antineoplastic Agents
  • Biomarkers

Grants and funding

This work was supported by Grant N. 40H73 from “Ministero del lavoro, della salute e delle politiche sociali.” The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.