Medical First
- Paul Edmonds, a 68-year-old man with a 33-year history of HIV-1 infection, who previously underwent a stem-cell transplant to treat acute myelogenous leukemia, no longer has detectable HIV or leukemia five years after having the procedure.
- AML is a fast-growing blood cancer that begins in the bone marrow, the factory that makes white and red blood cells and platelets. AML symptoms may include fatigue, loss of appetite, flu-like symptoms, pale skin, and fever. AML treatment may include strong chemotherapy and a stem cell transplant, which gives the patient healthy cells to replace the ones that chemotherapy may have killed.
- You can find SurvivorNet’s full resources for AML here.
- Not all people with AML are candidates for stem-cell transplants. Doctors evaluate each person’s individual risk potential to determine who is a candidate for one.
- Stem cells are the early blood cells that chemotherapy destroys during lymphoma treatment. The doctor will remove healthy stem cells from your blood about a week before the transplant. After you get chemotherapy, you’ll have an infusion of those stem cells to replace the cells your treatment destroyed
Paul Edmonds, who has been free of HIV-1 for 35 months now, had the stem-cell transplant done at the City of Hope, a non-profit clinical research center and hospital, using cells from a donor with a rare genetic mutation, according to MedPage Today
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There is no cure for HIV, however, it can be managed or treated with the appropriate medicine. A common treatment option for people with HIV is antiretroviral therapy; this treatment can extend the life of a patient with the HIV virus, as the medicine stops the virus from duplicating itself. This duplication, or copying, destroys the patient’s immune system.
According to MedPage Today, Dr. Jana Dickter, MD, of City of Hope National Medical Center and her colleagues wrote in the New England Journal of Medicine that Edmonds received a hematopoietic stem cell transplant (HPSCT) from a donor with the rare delta-32 mutation, “which causes a CCR5 deletion (CCR5-Δ32/Δ32) and has been associated with resistance to HIV-1 infection.”
As per the National Library of Medicine, a hematopoietic stem cell transplant (HPSCT) “involves administering healthy hematopoietic stem cells to patients with dysfunctional or depleted bone marrow.” and assists in augmenting bone marrow function, as well as allow for the “destruction of malignant tumor cells.” It can also create functional cells that replace the dysfunctional ones.
Dr. Dickter told MedPage Today in a recent interview, “He was the oldest person to successfully undergo a stem cell transplant with HIV and leukemia and then achieve remission from both conditions.
“He also had been living with HIV the longest of any of the patients to date — for more than 31 years — prior to transplant.
She added, “His case opens up the possibilities for other older persons living with HIV and a blood cancer to receive a transplant and achieve remission for both diseases if a donor with this rare genetic mutation [delta-32] can be identified.”
When Edmonds story was initially shared by City of Hope in 2022, the patient wished to remain anonymous, but last year he decided to tell his story “to bring some hope for people with HIV, snd I want to remember all those we lost.”
Edmonds, a resident of Desert Hot Springs, California, received stem cells from his donor back in February of 2019, when he was just 63.
Recounting the procedure to City of Hope, he said, “Transplant was a breeze. I started feeling pretty good almost immediately and just continued to feel really good.”
Edmonds, who now works as a caregiver for people with disabilities and older adults, also admitted, “Even though I knew AML could be fatal, I never once believed that I would not make it. I never gave up, and I never felt hopeless.”
Speaking to City of Hope about the success in finding “so many tools for people with HIV that are effective and well-tolerated,” Dickter said, “As people living with HIV age, they are at a higher risk for developing age-related cancers, including hematologic malignancies. For those who would benefit from a stem cell transplant to treat their cancer, the idea that they could go into remission from HIV simultaneously is amazing.
“It’s incredible to think that when I was a fellow so many years ago, the idea of having someone effectively cured of their HIV seemed almost impossible, or something that I would never see or experience firsthand.”
Meanwhile, Joel Blankson, MD, PhD, of Johns Hopkins Medicine in Baltimore told MedPageToday that the current evident isn’t enough to support extended use of stem cell transplantation to cure HIV.
He explained, “The problem is we don’t know what the denominator is. We don’t know how many times it’s been tried. But it is very encouraging that we’ve gone past ‘N is equal to one’ to the point where we now have ‘N is equal to five’ [reference to the five patients known to be in HIV remission after bone marrow transplants].”
Understanding Acute Myelogenous Leukemia
Acute myeloid leukemia is a fast-growing blood cancer that begins in the bone marrow, the factory that makes white and red blood cells and platelets.
Within the bone marrow are stem cells that eventually develop into white blood cells (WBCs), red blood cells (RBCs), and platelets, which help blood clot.
Expert Resources On Leukemia
- Acute Myeloid Leukemia (AML)–An Overview of Initial Treatment
- Acute Myeloid Leukemia (AML) — What Are The Symptoms?
- Acute Myeloid Leukemia (AML): How Do I Make Treatment Decisions?
- Advancements in Treating Acute Myeloid Leukemia (AML)
- A Deep Look Into The Powerful Drugs for Chronic Myeloid Leukemia: Tyrosine Kinase Inhibitors (TKIs)
- Stem Cell Transplant for Chronic Myeloid Leukemia: What Do You Need to Know?
- Understanding the Key Differences Between Acute and Chronic Myeloid Leukemias (AML vs. CML)
Stem cells can copy themselves to make progenitor cells or precursor cells. Myeloid progenitor cells turn into red blood cells, granulocytes (a type of white blood cell), and platelets. AML affects the myeloid progenitor cells during a stage of development when they are called myeloblasts.
With AML, myeloblasts fail to turn into fully developed blood cells, leaving them to build up in the bone marrow and blood.
WATCH: An AML Diagnosis What are the Next Steps?
AML is diagnosed by extracting samples of liquid bone marrow and a chip of bone from the back of the hip. The samples are then tested to determine if blood cells in the bone marrow are abnormal.
Dr. Gail Roboz, an AML expert and medical oncologist at Weill Cornell Medicine, told SurvivorNet in an earlier interview, “The majority of patients have this sporadically out of the clear blue sky.”
Symptoms for acute myeloid leukemia can include:
- Flu-like symptoms
- Fatigue
- Fever
- Loss of appetite
Symptoms of acute myeloid leukemia
AML causes certain symptoms, but having these symptoms doesn’t necessarily mean you have AML. Your doctor will do diagnostic tests to confirm whether you have AML before recommending a treatment.
Your doctor will then perform tests to diagnose you, and those tests include:
- Blood tests. In people with AML, white blood cell counts may be high, and red blood cell and platelet counts may be low. These tests can also show immature cells in the blood that should only be found in the bone marrow.
- Bone marrow biopsy. Removing and testing a sample of the bone marrow helps to confirm AML after an abnormal blood test result.
- Lumbar puncture. This test uses a sample of spinal fluid to diagnose AML.
- Molecular and genetic testing. Your doctor can do tests to determine whether you have certain genes related to AML and if your cancer might respond to specialized treatments.
Treating AML
For people deemed healthy enough, induction therapy is the standard treatment for AML. The process involves a seven-day chemotherapy regimen, followed by several weeks of recovery. The goal of this high dose of chemo is to induce remission.
A stem cell transplant is another option for treating AML. After a high dose of chemotherapy, a stem cell transplant gives the patient healthy cells to replace the ones that chemotherapy may have killed.
WATCH: Understanding AML Stem Cell Transplant process.
After chemo and a transplant, the recovery process can be difficult because the immune system will be compromised. Finding a genetic match in a donor may also be difficult.
Other newer treatments are being tested in clinical trials. Ask your doctor if any therapies under investigation might be appropriate for you.
The effects of leukemia treatment are very individualized. Treatment may get rid of all leukemia cells for some people, while others will have to remain on chemotherapy long-term to control their cancer. Expect to have follow-up exams after treatment, usually every month to begin with and then at longer intervals.
RELATED: Finding The Ideal Donor For A Stem Cell Transplant
Even though AML cancer warriors may complete treatment, there is always the chance of a relapse. The timing of the relapse plays a significant role in which treatment route your doctor will advise.
“Unfortunately for many patients with AML, their disease will come back, and we call that a disease relapse,” Dr. Tara Lin, director of the Acute Leukemia Program at the University of Kansas Medical Center, previously told SurvivorNet.
“It’s really important that when a patient has a relapse of their disease, they see someone who has a lot of experience in treating AML.”
Learning About Stem Cell Transplants & How They Work
According to Dr. Jing Ye of University of Michigan Health, the goal of a stem cell transplant is to prolong a multiple myeloma patient’s “progression-free survival.” This does not mean curing multiple myeloma it means extending the period of time in which the disease does not gain ground.
The Stem Cell Transplant, a Day-by-Day Guide
Step 1: Removing the Cells
The first step of a stem cell transplant involves extracting blood-making cells from the patient’s body.
Patients receive a daily injection of growth factor to promote growth of stem cells and delivery from the bone marrow into the blood stream.
RELATED: Is a Stem Cell Transplant Always Needed for Multiple Myeloma Treatment?
From there, blood is collected through an IV, and spun in a machine that enables doctors to isolate the layer of blood cells they want. These cells are collected and frozen, and the remaining blood is put back into the body. These frozen cells can be stored for years, but they are typically reintroduced into the body in the first window of response to treatment or after the first phase of induction therapy.
Step 2: Induction
After the stem cells are extracted, the person being treated will undergo high-dose chemotherapy. According to Dr. Ye, this chemotherapy is intended to “eradicate all the myeloma cells in the bone marrow.” Unfortunately, this isn’t the only effect of chemotherapy. “The side effect is at the same time, all the cells will be killed along with those cancer cells,” said Dr. Ye.
RELATED: Side Effects from Multiple Myeloma Treatment
“Once a patient has received this therapy, their bone marrow will have a dramatic decrease of myeloma cells and healthy cells,” Dr. Ye explained. The goal of the stem cells is to assist with recovery of blood counts following high dose chemotherapy.
Step 3: Stem Cells Are Returned, and Blood-Making Resumes
Without a stem cell transplant, the high-dose chemotherapy treatment would cause the patient’s blood counts to dip dangerously low, and to stay low for a long period of time. Instead, doctors wait a day until the chemotherapy has left the bloodstream, and then they re-infuse the blood-making cells that they had stored back into the body.
RELATED: What To Expect During Recovery After a Stem-Cell Transplant For AML
Once the blood-making cells are back in the patient’s body, they move into the bone marrow and start making blood. The production of blood will resume ten to fourteen days after the cells are re-introduced into the body.
WATCH: What Are The Options For Patients When Acute Myeloid Leukemia.
Contributing: SurvivorNet Staff
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