Autologous hematopoietic cell transplantation for HIV-related lymphoma: results of the (BMT CTN) 0803/(AMC) 071 Trial

Joseph C. Alvarnas, Jennifer Le Rademacher, Yanli Wang, Richard F. Little, Gorgun Akpek, Ernesto Ayala, Steven Devine, Robert Baiocchi, Gerard Lozanski, Lawrence Kaplan, Ariela Noy, Uday Popat, Jack Hsu, Lawrence E. Morris Jr., Jason Thompson, Mary H. Horowitz, Adam Mendizabal, Alexandra Levine, Amrita Krishnan, Stephen J. Forman, Willis H. Navarro and Richard F. Ambinder

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  • RE: Curing HIV with Hematopoietic Cell Transplantation
    • Lawrence D. Petz, Medical Director StemCyte International Cord Blood Center Baldwin Park, California
    • Other Contributors:
      • Joanne Kurtzberg, Director, Pediatric Blood and Marrow Transplant Program; Director, Carolinas Cord Blood Bank
      • Donna M. Regan, Director, St. Louis Cord Blood Bank & Cellular Therapy Laboratory
      • Elizabeth Shpall, Director, Cell Therapy Laboratory; Director, Cord Blood Bank

    Curing HIV with Hematopoietic Cell Transplantation

    Alvarnas et al. (1) concluded that HIV-infected lymphoma patients should be considered candidates for autologous hematopoietic cell transplantation. Although 40 patients received transplants, none were done with intent to cure the HIV as well as the underlying malignancy, although this has been accomplished with allogeneic hematopoietic stem cell transplantation by Hütter et al. (2) who used stem cells from a donor with a homozygous CCR5 mutation. One could argue that in these patients, an approach that could also cure their HIV should be considered.
    Well documented important adverse effects of long-standing HIV infection exist even in this modern era of antiretroviral therapy. These include a 25-fold increased incidence of non-Hodgkin lymphoma (1), infections, heart disease, cancer, liver disease and kidney disease (3, 4). The associated stigma has a serious impact on the quality of life, and the life span of infected patients is substantially shorter than that of HIV-uninfected peers (3). One cannot live a normal life if infected with HIV.

    As is well known by the authors, inventories exist of hundreds of cryopreserved homozygous CCR5-negative cord blood units. The necessity of a very close HLA match makes finding HLA-matched adult CCR5-negative units extremely unlikely, but cord bloods require significantly less stringent HLA matching. Further, numerous publications indicate that outcomes after cord...

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    Conflict of Interest:
    None declared.