Testing cord blood transplants as a cure for leukemia — and HIV
When the news came out last month that a New York woman was likely cured of HIV/AIDS by the same cord blood transplant she had received to save her from leukemia, Dr. Filippo Milano’s telephone at Seattle’s Fred Hutchinson Cancer Research Center began to ring.
The unnamed New York patient had been given a transplant in August 2017 using donated umbilical cord blood with genes naturally resistant to HIV, the virus that causes AIDS. The transplant cured her cancer, as anticipated, and more than four years later her doctors at Weill Cornell Medicine are confident it cured her HIV as well.
Although HIV is a treatable condition for those who have access to antiviral drugs, as soon a person stops that treatment, the virus rebounds. Four-and-a-half years post-transplant, and with no detectable virus 14 months after stopping her drugs, the New York patient appears to be only the third person ever cured of HIV, which has infected 80 million worldwide since 1981.
“The first thing we will tell the patient is that the transplant is to cure your cancer, not your HIV. But while we are curing your cancer with the transplant, it might be possible to cure your HIV,” said Milano. The trial will be conducted at Fred Hutch and at least three other medical centers across the country.
With funding from the National Heart, Lung, and Blood Institute, this Phase 2 trial aims to enroll 10 patients with leukemia who are also HIV-positive. As was done in New York, they will receive, as a treatment for their cancer, transplanted stem cells from cord blood. Because that cord blood in this trial will come from donors with rare genes that confer resistance to HIV, the hope is that the procedure will give them immunity against HIV as well.
Participants in the trial also get a second infusion of cord blood-derived cells meant to give patients a burst of protection against infection during several vulnerable weeks before the transplanted stem cells engraft and rebuild a fully functioning immune system.
