Allogeneic haematopoietic stem cell transplantation in patients with human immunodeficiency virus: the experiences of more than 25 years

Abstract

SummaryFor treatment of several malignancies, transplantation of allogeneic haematopoietic stem cells (HSCT) derived from bone marrow or peripheral blood has been used as a therapeutic procedure for decades. In the past, HSCT has been suggested as a treatment option for infection with the human immunodeficiency virus type 1 (HIV-1), but these attempts were mostly unsuccessful. Today, after the introduction of an active anti-retroviral therapy, the lifetime expectancy of HIV-infected patients has improved substantially, but nevertheless the incidence rate of malignancies in these patients has increased considerably. Therefore, it can be assumed that there will be a rising necessity for HIV-1-infected patients with malignancies for allogeneic HSCT. At the same time, there is increasing interest in treatment methods which might target the HIV-1 reservoir more effectively, and the question has been raised as to whether allogeneic HSCT could be linked to such strategies. In this paper the data of more than 25 years experience with allogeneic HSCT in patients with HIV-1 are reviewed and analysed.

Hematopoietic stem cell transplantation for HIV cure

“…Holland, cited in ref. 7). In another case, a 25-year old woman with AIDS who received an allogeneic HSCT from a matched, unrelated donor after conditioning with busulfan and cyclophosmaide in the setting of ART with zidovudine and IFN-α2 survived for 10 months before succumbing to adult respiratory distress syndrome (12); tissues obtained at autopsy were negative for HIV-1 by PCR.…”

“…The history of HSCT in HIV-infected patients has been reviewed by Hütter and Zaia (7). Early attempts to apply HSCT as an approach to immune reconstitution in patients with AIDS or as treatment for hematologic malignancies met with little success (8)(9)(10).…”

Hematopoietic cell transplantation and HIV cure: where we are and what next?

“…5 In addition to the Berlin patient, there have been early-stage clinical studies of engineered human progenitor cells and T cells expressing anti-HIV moieties, including CCR5-inactivated T cells. [6][7][8][9][10][11][12][13][14][15] These studies demonstrated the safety and feasibility of such therapies, but their efficacy is yet to be evaluated.…”

Significant interaction of tacrolimus with ritonavir during allogeneic hematopoietic SCT in an HIV-infected patient

“…8 Survival is significantly better among patients that received HAART, as compared with those in the pre-HAART era. 14 Our case highlights one of the serious drug interactions encountered during allogeneic HSCT in patients receiving HAART.…”

“…5 --7 However, available data are scant for allogeneic HSCT in the setting of HIV infection. 8 HIV-infected patients undergoing allogeneic HSCT are likely to experience many drug --drug interactions in view of the concurrent use of multiple drugs. In this report, we describe a case of a serious interaction between tacrolimus and the HIV protease inhibitor ritonavir in an HIV-infected patient who underwent an allogeneic HSCT for refractory non-Hodgkin's lymphoma.…”