Transplanting in uncharted territory
Autologous stem cell transplant for HIV-related lymphomas is well established at Groote Schuur Hospital. In contrast, allogeneic stem cell transplantation in the context of HIV infection has remained uncharted territory. July 2022 ushered in a new era for Groote Schuur’s Clinical Haematology Division, with the first allogeneic stem cell transplantation in state sector for a person living with HIV.
With no official guidelines and only a handful of case reports published on allogeneic transplant for severe aplastic anaemia in HIV, embarking on this journey required careful planning and the support of a multidisciplinary team. Thankfully, the transplant and subsequent engraftment proceeded uneventfully despite several potential pitfalls including drug interactions and opportunistic infections. At day 100, the recipient was transfusion independent, had a near normal full blood count and showed full donor chimerism.
In the words of the patient, “I never thought I would still be alive by this time. I had so many limitations. It was impossible for me to do basic activities such as walking and bathing. I didn’t know what to expect. With the support I got from my doctors and other staff, I sourced the strength to push through. Its only just over 100 days post-transplant and I feel much power and energy and my life is filled with positive thoughts and behaviour. I am filled with gratitude, focus and life”.
With the world’s greatest burden of HIV, South African clinicians and scientists have a unique opportunity to both deeply understand the disease and find practical solutions to the issues at hand. Haematology is no exception, and hopefully the experience gained through this endeavour takes us all a step towards this end.