Highly active antiretroviral therapy and allogeneic CD34+ peripheral blood progenitor cells transplantation in an HIV/HCV coinfected patient with acute myeloid leukemia

Federica Sorà, Andrea Antinori, Nicola Piccirillo, Andrea De Luca, Patrizia Chiusolo, Antonella Cingolani, Luca Laurenti, Sergio Rutella, Luigi Ortona, Giuseppe Leone, Simona Sica

Research output: Contribution to journalArticle

Abstract

Objective. To evaluate the safety, feasibility, and efficacy of allogeneic stem cell transplantation (SCT) for acute myelogenous leukemia (AML) in a young female coinfected by HIV and HCV undergoing highly active antiretroviral therapy (HAART). Patient and Methods. A 33-year-old female HIV+, HCV+ in complete remission after standard chemotherapy was submitted to CD34+ selected allogeneic transplantation from her HLA-identical HIV- brother after myeloablative regimen. HAART was started before transplantation, achieving a reduction of HIV load to undetectable levels. GVHD prophylaxis was carried out with cyclosporine A alone. Results. The patient achieved prompt and durable engraftment with acute GVHD grade II easily managed with steroids; CMV prophylaxis was prolonged, no clinically relevant infectious complications developed early after transplantation and during follow-up. HIV viremia was controlled by HAART although medication adherence was reduced early after transplantation and required drug adjustment. There was a gradual recovery of immune cells with normal CD4-cell count 39 months after engraftment, a significantly higher level than before transplantation. At 39 months posttranplantation follow-up the patient is alive and in continuous complete remission with undetectable levels of plasma HIV RNA on HAART. Conclusion. The introduction of HAART has recently changed the paradigm of AIDS, allowing the control of HIV replication, the reduction of opportunistic infections, and the overall improvement of survival. One may therefore reconsider the current exclusion of patients with AIDS and a concomitant lethal malignancy from programs of high-dose chemotherapy and stem cell transplation, as suggested by this report.

Original languageEnglish
Pages (from-to)279-284
Number of pages6
JournalExperimental Hematology
Volume30
Issue number3
DOIs
Publication statusPublished - 2002

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Cell Transplantation
Highly Active Antiretroviral Therapy
Acute Myeloid Leukemia
Blood Cells
Stem Cells
HIV
Transplantation
Acquired Immunodeficiency Syndrome
Social Adjustment
Drug Therapy
Medication Adherence
Viremia
Homologous Transplantation
Opportunistic Infections
Stem Cell Transplantation
CD4 Lymphocyte Count
Cyclosporine
Siblings
Steroids
RNA

ASJC Scopus subject areas

  • Cancer Research
  • Cell Biology
  • Genetics
  • Hematology
  • Oncology
  • Transplantation

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Highly active antiretroviral therapy and allogeneic CD34+ peripheral blood progenitor cells transplantation in an HIV/HCV coinfected patient with acute myeloid leukemia. / Sorà, Federica; Antinori, Andrea; Piccirillo, Nicola; De Luca, Andrea; Chiusolo, Patrizia; Cingolani, Antonella; Laurenti, Luca; Rutella, Sergio; Ortona, Luigi; Leone, Giuseppe; Sica, Simona.

In: Experimental Hematology, Vol. 30, No. 3, 2002, p. 279-284.

Research output: Contribution to journalArticle

Sorà, Federica ; Antinori, Andrea ; Piccirillo, Nicola ; De Luca, Andrea ; Chiusolo, Patrizia ; Cingolani, Antonella ; Laurenti, Luca ; Rutella, Sergio ; Ortona, Luigi ; Leone, Giuseppe ; Sica, Simona. / Highly active antiretroviral therapy and allogeneic CD34+ peripheral blood progenitor cells transplantation in an HIV/HCV coinfected patient with acute myeloid leukemia. In: Experimental Hematology. 2002 ; Vol. 30, No. 3. pp. 279-284.
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AU - Sorà, Federica

AU - Antinori, Andrea

AU - Piccirillo, Nicola

AU - De Luca, Andrea

AU - Chiusolo, Patrizia

AU - Cingolani, Antonella

AU - Laurenti, Luca

AU - Rutella, Sergio

AU - Ortona, Luigi

AU - Leone, Giuseppe

AU - Sica, Simona

PY - 2002

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N2 - Objective. To evaluate the safety, feasibility, and efficacy of allogeneic stem cell transplantation (SCT) for acute myelogenous leukemia (AML) in a young female coinfected by HIV and HCV undergoing highly active antiretroviral therapy (HAART). Patient and Methods. A 33-year-old female HIV+, HCV+ in complete remission after standard chemotherapy was submitted to CD34+ selected allogeneic transplantation from her HLA-identical HIV- brother after myeloablative regimen. HAART was started before transplantation, achieving a reduction of HIV load to undetectable levels. GVHD prophylaxis was carried out with cyclosporine A alone. Results. The patient achieved prompt and durable engraftment with acute GVHD grade II easily managed with steroids; CMV prophylaxis was prolonged, no clinically relevant infectious complications developed early after transplantation and during follow-up. HIV viremia was controlled by HAART although medication adherence was reduced early after transplantation and required drug adjustment. There was a gradual recovery of immune cells with normal CD4-cell count 39 months after engraftment, a significantly higher level than before transplantation. At 39 months posttranplantation follow-up the patient is alive and in continuous complete remission with undetectable levels of plasma HIV RNA on HAART. Conclusion. The introduction of HAART has recently changed the paradigm of AIDS, allowing the control of HIV replication, the reduction of opportunistic infections, and the overall improvement of survival. One may therefore reconsider the current exclusion of patients with AIDS and a concomitant lethal malignancy from programs of high-dose chemotherapy and stem cell transplation, as suggested by this report.

AB - Objective. To evaluate the safety, feasibility, and efficacy of allogeneic stem cell transplantation (SCT) for acute myelogenous leukemia (AML) in a young female coinfected by HIV and HCV undergoing highly active antiretroviral therapy (HAART). Patient and Methods. A 33-year-old female HIV+, HCV+ in complete remission after standard chemotherapy was submitted to CD34+ selected allogeneic transplantation from her HLA-identical HIV- brother after myeloablative regimen. HAART was started before transplantation, achieving a reduction of HIV load to undetectable levels. GVHD prophylaxis was carried out with cyclosporine A alone. Results. The patient achieved prompt and durable engraftment with acute GVHD grade II easily managed with steroids; CMV prophylaxis was prolonged, no clinically relevant infectious complications developed early after transplantation and during follow-up. HIV viremia was controlled by HAART although medication adherence was reduced early after transplantation and required drug adjustment. There was a gradual recovery of immune cells with normal CD4-cell count 39 months after engraftment, a significantly higher level than before transplantation. At 39 months posttranplantation follow-up the patient is alive and in continuous complete remission with undetectable levels of plasma HIV RNA on HAART. Conclusion. The introduction of HAART has recently changed the paradigm of AIDS, allowing the control of HIV replication, the reduction of opportunistic infections, and the overall improvement of survival. One may therefore reconsider the current exclusion of patients with AIDS and a concomitant lethal malignancy from programs of high-dose chemotherapy and stem cell transplation, as suggested by this report.

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