News in brief: Leukaemia patient has HIV remission after cord blood stem cell transplant; Early anticoagulant use may prevent recurrent silent brain infarction; Chemo patients not getting cardiotoxicity screening

Thursday, 17 Feb 2022

Leukaemia patient has HIV remission after cord blood stem cell transplant

A woman with HIV who received a cord blood stem cell transplant to treat acute myeloid leukemia has had no detectable levels of HIV for 14 months despite cessation of antiretroviral therapy (ART), US researchers have reported.

The case presented at the Conference on Retroviruses and Opportunistic Infections (CROI), related to a woman who had been on antiretroviral therapy for HIV infection for four years at the time of her acute myeloid leukemia diagnosis. She achieved acute myeloid leukemia remission after chemotherapy. And then in 2017 received a transplant of CCR5Δ32/Δ32 cord blood stem cells supplemented with adult donor [haplo] cells from a relative.

According to a statement from the NIH which funded the research, the patient achieved engraftment with 100% cord blood cells at day 100 and had no detectable HIV. At 37 months post-transplant, the patient stopped antiretroviral therapy. No HIV was detected in the participant for 14 months, except for a transient detection of trace levels of HIV DNA in the woman’s blood cells at 14 weeks after stopping antiretroviral therapy. The haplo cells only transiently engrafted and contributed to rapid recovery, the researchers said.

HIV remission resulting from a stem cell transplant had been previously observed in two cases, they noted.

Early anticoagulant use may prevent recurrent silent brain infarction

Earlier anticoagulant use may offer some advantage against recurring silent brain infarctions, an Australian neurologist has told the 2022 International Stroke Conference.

A review of 215 patients with silent brain haemorrhage or infarct found those starting anticoagulants within seven days of their index event had a slight, though statistically non-significant, reduction in infarct recurrence risk at 30-days’ follow-up, compared with late-starters.

Of the 172 early-starters, 11% had recurring infarct on brain MRI, versus 19% in the late anticoagulation group (odds ratio [OR]: 0.54, 95% CI: 0.22–1.34, P = 0.19), Neurologist and Royal Melbourne Hospital Stroke Fellow Dr Angelos Sharobeam reported.

The drug didn’t affect silent haemorrhage rates, however, with the condition seen in 26% and 28% of early- or late-starters, respectively (OR: 0.86, 95% CI: 0.40–1.82, P = 0.69).

Chemo patients not getting cardiotoxicity screening

Very few cancer patients treated with cardiotoxic chemotherapy receive the recommended baseline transthoracic echocardiogram (TTE) prior to starting therapy, an Australian study shows.

A review of records for 712 cancer patients starting treatment at a NSW hospital found that only 14.4% of those assigned to receive cardiotoxic chemotherapy had a baseline TTE, a level similar to a control group of patients not receiving cardiotoxic chemotherapy (13.9%).

Uptake of baseline TTE was slightly higher (40%) in a subgroup of 27 patients (4%) who deemed at very high risk of cardiotoxicity.

Patients receiving cardiotoxic chemotherapy were however more likely to have received a TTE during the course of treatment (32.3% vs 23.2%, p = 0.009), according to findings published by clinicians at Blacktown Hospital, Sydney in the European Heart Journal.

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