Combining forces against HIV infection and lymphoma: a case report Chemotherapy + total body irradiation + bone marrow transplant yields exciting results HIV infection of the bone marrow ultimat e ly leads to AIDS. Although allogeneic bone marrow transplantation has been evaluated previously, the donated marrow has become infected by HIV. Combination of zidovudine therapy with bone marrow transplant may pre vent the infection of donat ed marrow. A 41-year-old man with HIV-1 infection and non Hodgkin's lymphoma received combination therapy with antineoplastics and was scheduled for bone marrow transplantation . Zidovudine therapy was initiated 14 da ys bef ore bon e rarrow transplantation and was continu ed juring and after the procedure . IV cyclophosphamide was administered for 5 days followed by total body irradiation for 4 days and bone marrow transplant on the tenth day. The donor was the HLA-identical and ABO compatible sister of the patient. Cyclosporin and aciclovir were administered postoperativ ely as prophylaxis against graft-v er sus-host disease and viral infections, respectivel y. The patient progressed we ll until a recurrence of lymphoma was noted on da y 39 and all therapy except zidovudine was withdrawn. Th e patient died on day 47 from respiratory failure. Assays for HIV infection (culture of polymophonuclear cells, Western blot assay a nd polymerase chain reaction gene amplification) were positive before the procedure. After postoperative day 32, polymerase chain reaction gene amplification and culture were unable to detect HIV, Western blot assay showed a persistent decline of antibodies to viral antigen after bone marrow transplantation and no HIV p24 antigen was detected at any time. 'Our results suggest that the therapeutic approach we used may have eradicated the HIV-I reservoir of infected cells by 6 weeks after transplantation.' Further studies are warranted in patients with HIV inf ec tion and po or prognosis ly mphom a, if these studies support the findings of this case report. ' ... this approach may be applicable to a larger group of patients who are infected with HIV-/' as a possible curative therapy. Ho li and ilK . Saral R. Ross i . 1.1 . Do nn c nhcrg .AD. Rurn s W H o t't a l. --\lIogc neic honc marrow transplantation, l.idovudillC'_ and hum an im mllnodclirit'ncy " irlls type I OllV . I) inf ,'nion . Studi ," in a patient with non-Hodgkin lymphoma . Annals of Interna l Medi r ine III' 973- 9R I . I 5 Ocr 1989 ,." , 1

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Page 1: Combining forces against HIV infection and lymphoma: a case report

Combining forces against HIV infection and lymphoma: a case report Chemotherapy + total body irradiation + bone marrow transplant yields exciting results

HIV infection of the bone marrow ultimately leads to AIDS. Although allogeneic bone marrow transplantation has been evaluated previously, the donated marrow has become infected by HIV. Combination of zidov udine therapy with bone marrow transplant may prevent the infection of donated marrow.

A 41-year-old man with HIV-1 infection and non Hodgkin's lymphoma received combination therapy with antineoplastics and was scheduled for bone marrow transplantation . Zidovudine therapy was initiated 14 days before bone rarrow transplantation and was continued juring and after the procedure. IV cyclophosphamide was administered for 5 days followed by total body irradiation for 4 days and bone marrow transplant on the tenth day. The donor was the HLA-identical and ABO compatible sister of the patient. Cyclosporin and aciclovir were administered postoperatively as prophylaxis against graft-versus-host disease and viral infections, respectivel y. The patient progressed well until a recurrence of lymphoma was noted on day 39 and all therapy except zidovudine was withdrawn. The patient died on day 47 from respiratory failure .

Assays for HIV infection (culture of polymophonuclear cells, Western blot assay and polymerase chain reaction gene amplification) were positive before the procedure. After postoperative day 32, polymerase chain reaction gene amplification and culture were unable to detect HIV, Western blot assay showed a persistent decline of antibodies to viral antigen after bone marrow transplantation and no HIV p24 antigen was detected at any time.

'Our results suggest that the therapeutic approach we used may have eradicated the HIV-I reservoir of infected cells by 6 weeks after transplantation.' Further studies are warranted in patients with HIV infection and poor prognosis lymphoma, if these studies support the findings of this case report. ' ... this approach may be applicable to a larger group of patients who are infected with HIV-/' as a possible curative therapy. Holiand ilK. Sara l R. Rossi .1.1 . Do nncnhc rg .AD. Rurn s W H o t't a l. --\lIogc neic honc marrow transplantation, l.idovudillC'_ and human im mllnodclirit'ncy " irll s type I OllV . I) inf,'nion . Studi ," in a patient with non-Hodgkin lymphoma. Annal s of Interna l Medi r ine III' 973-9R I . I 5 Ocr 1989 ,." ,