Autologous Stem Cell Transplant for HIV-Associated Lymphoma: A Systematic Review and Meta-Analysis.

BACKGROUND: Despite improved outcomes with antiretroviral therapy, HIV-associated lymphoma (HAL) remains a major cause of mortality. Autologous stem cell transplant (ASCT) may be curative for relapsed/refractory (R/R) HAL, but HIV-related immunosuppression complicates management. We systematically reviewed prospective evidence on ASCT efficacy and toxicity in HAL. METHODS: PubMed, Cochrane, Embase, and ClinicalTrials.gov were searched for publications between 1 January 1996 and 21 June 2026, with an initial search in January 2024 updated in June 2026. Non-English studies, retrospective analyses, studies with fewer than 10 eligible patients, and studies of primary CNS lymphoma were excluded. Studies of first-line ASCT were included for toxicity analysis but excluded from efficacy analysis. Analyses were performed using MedCalc v22.032. RESULTS: 378 titles were screened, 350 underwent abstract review and 40 full-text review. Six non-randomized prospective studies were identified. Identified trials included a total of 134 patients (33 Hodgkin lymphoma, 101 non-Hodgkin lymphoma). Median age and CD4 counts reported by individual studies ranged from 39 to 47 years and 172-279 cells/µL, respectively; 94.2% of patients were male. All patients received antiretroviral therapy at time of ASCT. Pooled six-month non-relapse mortality (NRM) was 5.39% (95% CI: 2.28-9.73). Among the 52 R/R HAL patients with survival data available, estimated 2-year overall survival (OS) and progression-free survival (PFS) were 79.8% (95% CI: 68.1-89.3) and 77.9% (95% CI: 65.9-87.8), respectively. CONCLUSIONS: In this first systematic review and meta-analysis of ASCT for HAL, NRM post-ASCT is consistent with historical trial results in the non-HIV population. OS and PFS are encouraging, but prospective data are limited and comparative data is absent.