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Is a stem cell transplant for me? Would I survive it? How has HIV trashed my body so quickly?
Nov 25, 2001

I have a question concerning Stem Cell transplant. The procedure is high dose chemotherapy to wipe out bone marrow, followed by a stem cell transplant. Normally one is admitted to the hospital for several weeks. Now with HIV we can't get high dose or even regular strength chemo, so how is the transplant done for us? This is my third round of chemo since last Oct,2000 for NHL, and my viral load has been undectable since Aug,2000. I always respond well to chemo; I just never get past 7 weeks post treatment when the lymphoma comes back. I know if this dosen't work, then I will proberly die.

Second question- How do you go from been HIV negative in March 1999, diagnosed with AIDS April 2000, and then in Oct diagnosed with stage 4 lymphoma,and between that time my VL has for the most part been undetectable. My CD4 count is stable at 291. Explain to me how the HIV trashed my body with only such a small viral load. I've been a nurse for over 20 years and I've never seen this.

Response from Dr. Dezube

You ask to excellent questions-- 1) your suitability for stem cell transplant and 2) how you body got "trashed" (your words) so quickly.

STEM CELL TRANSPLANT- As you indicate this is a procedure by which you would get high dose chemotherapy to kill all the lymphoma cells followed by an infusion of stem cells to rescue your bone marrow. I disagree with you statement "that those with HIV can't get high dose or even regular strength chemo". This was true prior to highly active antiretroviral therapy (HAART). Since the advent of HAART, most patients, such as you, for whom the viral load is under control, can indeed receive regular strength chemotherapy and even high dose. You state that your tumor always responds, but only transiently so. You would make an excellent stem cell transplant candidate since it looks like your tumor will respond. In short, if your oncologist is willing to have you undergo a stem cell transplant, then I would recommend that you go through it. This would be you best chance at making the lymphoma history. The concept of stem cell transplant for relapsed HIV lymphoma is relatively new, so unfortunately little is written about the subject. There are a few small abstracts on the subject. My own take on the situation is that you should do almost as well as your HIV-negative counterpart, for whom much published literature exists. GOOD LUCK. (There is also one other procedure call mini-allo transplant, also known as transplant-lite, which is available at some select centers.)

Your second question deals with the rapidity of your disease. I believe your current situation is being dictated 100% by your cancer. In your case, the HIV is playing a distant second role, somewhere in the background. The HIV did nothing more than let the cancer start. The HIV is probably not contributing very much to your current sad saga. And yes, I have seen patients (unfortunately too many patients) with similar stories like yours; Good folks who had their HIV under control, who nevertheless developed galloping cancers. My message to you is that you should do what's in your best interest from a cancer standpoint. My best wishes to you. BD.

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