[CIS-PAGID] looking for transplant advice

[Church, Joseph]

Agreed.  JC

 

________________________________

From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Daniel Conway
Sent: Thursday, June 23, 2011 5:03 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS-PAGID] looking for transplant advice

 

I think Dr. Church's example argues for BMT to create the possibility of
immune reconstitution and therefore a cure.  
 
I cannot recall anyone with AIDS severe enough to get disseminated MAI
who got better prior to good anti-retroviral therapy and the consequent
immune reconstitution.  We had many with disseminated MAI that would
only progress despite increasing the number of drugs in the regimen.
The only change in clinical course for individuals with disseminated MAI
came with highly active anti-retroviral therapy and immune
reconstitution.

Sincerely, 
Daniel H. Conway, MD 
St. Christopher's Hospital for Children 
Drexel University College of Medicine  

________________________________

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> Date: Thu, 23 Jun 2011 16:26:58 -0700

> From: JChurch at chla.usc.edu

> To: pagid at list.clinimmsoc.org

> Subject: Re: [CIS-PAGID] looking for transplant advice

> 

> I would add the gamma interferon. We had a non-adherent teen with HIV

> and < 50 CD4+ cells for two years when he came in with disseminated

MAI.

> We gave him gamma interferon in addition to quad therapy. He decided

to

> take his meds and a year later he had >200 CD4's and multiple negative

> MAI PCRs. He remains on his HIV meds and is off all AFB therapy. The

> gamma interferon was very well tolerated at "CGD doses." JC

> 

> -----Original Message-----

> From: pagid-bounces at list.clinimmsoc.org

> [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Sullivan,

> Kathleen

> Sent: Thursday, June 23, 2011 12:20 PM

> To: pagid at list.clinimmsoc.org

> Subject: [CIS-PAGID] looking for transplant advice

> 

> I am posting this question on behalf of others but the big question

is:

> 

> Does it make more sense to transplant now or to try to achieve some

> clearance of mycobacteria prior to BMT?

> 

> The patient is a two year old with very low T cell numbers (CD3 about

> 100-200) and no TRECS. Her mitogens are not completely flat but about

> 2-4% of the control. She has immunoglobulin and B cells and has had

> some responses to vaccines. She had PCP and now presents with MAI and

> huge nodes. She was treated with triple therapy for about three weeks

> for her MAI and the nodes enlarged. We have increased her MAI coverage

> to 5 drugs and are thinking about adding gamma-interferon. We do not

> have a genetic type of SCID identified although she has a mutation of

> uncertain significance in the IL-7Ra gene and she has uniparental

> isodisomy of that chromosome.

> 

> Given this picture, what do other people think about hurrying to do a

> transplant on the theory that this is the only curative maneuver that

> can clear her MAI vs waiting to achieve some level of control and then

> transplanting?

> 

> 

> Kate

> 

> Kate Sullivan, MD PhD

> Professor of Pediatrics

> ARC 1216 Immunology CHOP

> 3615 Civic Center Blvd.

> Philadelphia, PA 19104

> (p) 215-590-1697

> (f) 267-426-0363

> 

> 

> 

> 

> 

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