HIV Drug May Prevent Bone Marrow Transplant Complication

WEDNESDAY, July 11 (HealthDay News) — An HIV drug significantly
reduced the risk of graft-versus-host disease, an all-too-common
complication in blood cancer patients following bone marrow transplants,
new research finds.

Bone marrow is the spongy tissue inside the bones that contains
immature cells, or stem cells. In an “allogeneic” bone marrow
transplantation, also called a stem cell transplant, a patient’s own stem
cells and immune system are wiped out by chemotherapy and radiation. Then,
the patient receives the transplant, or bone marrow, from a closely
matched donor.

The treatment is used for several types of blood cancers, including
lymphoma and leukemia.

But a common complication of a bone marrow transplant is
graft-versus-host disease. It occurs when transplanted immune cells attack
patients’ healthy tissue, a complication that can be minor or
life-threatening.

“Graft-versus-host disease affecting the skin, liver, gut and other
organs is a dreaded complication of allogeneic stem cell transplantation
either from a related or unrelated donor,” said one expert, Dr. Jasmine
Zain of NYU Langone Medical Center in New York City. “The rates are 35
percent with related donors and up to 57 percent by day 100, even in
reduced-intensity transplants,” added Zain, who is director of the Bone
Marrow Transplant Program and assistant professor in the division of
hematologic malignancies and medical oncology at the center.

The study was conducted by a team at the University of Pennsylvania’s
Perelman School of Medicine and included 38 patients with several types of
blood cancers. The cancers included acute myeloid leukemia,
myelodysplastic syndrome, lymphoma and myelofibrosis. All of the patients
were given the drugs tacrolimus and methotrexate, which suppress the
immune system and are a standard treatment to prevent graft-versus-host
disease.

The patients were also given a 33-day course of the HIV drug,
maraviroc, beginning two days before their transplant.

None of the patients treated with maraviroc developed graft-versus-host
disease in the gut or liver within the first 100 days after their
transplant. The liver and gut are the most serious locations for the
complication, the researchers noted.

After six months, 6 percent of these transplant patients developed
severe graft-versus-host disease compared to 22 percent of a group of
similar patients who weren’t treated with the HIV drug.

In addition, fewer in the group given the HIV drug developed
graft-versus-host disease in their liver or gut compared to those given
the standard treatment.

One year following transplant, about 15 percent of patients given the
HIV drug developed severe graft-versus-host disease compared to 29 percent
of patients who received standard therapy.

The study was published in the July 11 edition of the New England
Journal of Medicine
.

Researchers explained that the HIV drug redirects these immune cells
without having to suppress patients’ immune systems. Because their immune
systems aren’t compromised by the drug, patients should be less vulnerable
to infections and to a relapse of their cancer.

“It appears that our new approach allows us to prevent some patients
from developing [graft-versus-host disease] by redirecting immune cells
away from certain sensitive organs that they could harm,” lead study
author Dr. Ran Reshef, an assistant professor in the division of
hematology-oncology, said in a university news release. “This is a novel
way for us to try to decrease treatment-related complications among bone
marrow transplant patients without also reducing their new immune system’s
ability to attack their cancer.”

More research on the effects of longer-term treatment with maraviroc is
needed, they added.

For her part, Zain called the study “innovative.”

“There was no increase in the degree of immunosuppression, which is the
usual approach to prevent and treat graft-versus-host disease but comes at
a cost of increased infections and disease relapse,” Zain said. “This
makes this a novel and unique approach that should be investigated in a
larger trial.”

More information

The U.S. National Library of Medicine has more about bone marrow transplants.

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