chronic leukemia in HIV

Question

I'm a HIV positive indian doctor with CD4- 243 and past history of bacterial infections. viral load is 30,000 copies. Along with HIV I've been diagnosed with chronic myeloid leukemia (CML) [ chronic stage - blast cells NIL ]. philadelphia chromosome is positive. I am on 1 NNRTI+ 2 NRTI and hydroxyurea. the WBC count is controlled. No history of mycobacterial or opportunistic infections. Should I undergo bone marrow transplantation OR continue with only HAART ?

Answer

This is a hard question. If you were HIV negative, then many oncologists would push you to the bone marrow transplantation route. There is little experience however with transplantations in HIV positive patients. HIV itself may stimulate leukemia. What HIV does, is it causes the release of growth factors (e.g. the Tat protein); these factors in turn cause the release of growth factors (e.g bFGF) which in turn stimulate the leukemia cells. Although I have NO data on which to base my recommendation, my overall feeling about your case is that I would NOT recommend transplantion at this time. Basically I don't feel the risks of allogeneic transplant are justified in your situation. I would take whatever is necessary to control viral load. I would also recommend that you get information about "mini-transplant" (also known as Transplant-Lite). This has been VERY effective for CML and may be more tolerable given your HIV status. Also a new drug STI 1571 for CML is on the horizon. It is very promising. GOOD LUCK.