Bone Marrow Transplantation https://doi.org/10.1038/s41409-018-0297-z FEATURE Graft-versus-leukaemia effect post fludarabine, melphalan and alemtuzumab reduced intensity allogeneic stem cell transplant in HIV-infected patient with acute myeloid leukaemia A. Kanellopoulos 1 ● M. Kaparou 1 ● E. Xenou 1 ● S. Paneesha 1 ● B. Kishore 1 ● R. Lovell 1 ● K. Holder 1 ● J. Suhr 1 ● L. Baker 1 ● L. Ryan 1 ● E. Nikolousis 1 Received: 24 September 2017 / Revised: 5 June 2018 / Accepted: 21 July 2018 © Springer Nature Limited 2018 Allogeneic stem cell transplantation (Allo-HSCT) is sine qua non to cure high-risk acute myeloid leukaemia (AML). In spite the advent of highly active antiretroviral treatment, HIV-infected patients display a remarkable risk for haematological neoplasms such as non-Hodgkin lymphomas, Hodgkin lymphoma and acute leukaemia. Several case series have confirmed the efficacy of the autologous stem cell transplantation for the treatment of non-Hodgkin lymphomas in the HIV setting. Nonetheless, there is a paucity of data for the role of the Allo-HSCT in HIV-infected individuals with haematological malignancies. Herein, we presented the successful long-term outcome of a HIV-infected patient who received reduced intensity conditioned, matched unrelated donor transplant with alemtuzumab as graft-versus-host disease prophylaxis for therapy-related acute myeloid leukaemia. We propose that Allo-HSCT in HIV patients is safe and that alemtuzumab-based conditioning could further work to eradicate HIV in those whose donor is not CCR5 homozygous. A 29-year-old man was diagnosed in May 2003 with Ph negative, normal karyotype B-cell acute lymphoblastic leu- kemia (B-ALL) amid Mycobaterium avium intracellulare septicaemia (Table 1). In tandem with ALL, HIV-C3 infection was identified. At the time, CD4+ T-lymphocyte count was only 2 cells/mm 3 . Complete remission was attained post induction and central nervous system intensi- fication phases of the UKALL chemotherapy protocol. Consolidative autologous stem cell transplantation (auto- HSCT) conditioned with total body irradiation (TBI) ensued. In parallel, HIV infection was successfully treated with highly active antiretroviral treatment (HAART) (tenofovir, lamivudine and efavirenz) [1–3]. Interestingly delayed CD4 + T-cell reconstitution followed the first transplant as their count surpassed 200 cells/mm 3 only in 2006. In 2013, pro- gressive pancytopenia became evident: Hb 80 g/L white blood cells 5.1 × 109/L, platelets 48 × 10 9 /L, neutrophils 1.35 × 10 9 /L, mean corpuscular volume 115 fL. Bone mar- row biopsy exhibited dysplastic megakaryopoiesis and erythropoiesis, atypical eosinophils, myeloid maturation arrest, and significant excess of CD34+ blasts (~ 20% CD34 + CD117+ CD33+ blast cells at immunophenotyping). Karyotype analysis revealed complex abnormal karyotype including monosomy 7 and abnormal 17p in line with diagnosis of therapy-related acute myeloid leukaemia (AML). Patient was administered FLAG × 2 cycles (fludar- abine, high-dose cytarabine). Morphological remission was attained albeit the aberrant cytogenetic clone was present at the time of the human leukocyte antigen (10/10) matched unrelated donor allogeneic stem cell transplantation (Allo- HSCT) in February 2014. Transplant protocol consisted of fludarabine (30 mg/m 2 for 5 days), melphalan (140 mg/m 2 — single dose). Alemtuzumab (25 mg—2 doses on days -2 and -1) and Ciclosporin (day-1 until 2 months post trans- plant) were used for graft-versus-host disease (GVHD) prophylaxis. CD34+ stem cell dose was 6.03 × 10 6 /kg with the patient engrafting neutrophils and platelets day +15 and +13 respectively. Early post-transplant course was compli- cated from Hickman-line associated thrombosis and pneu- monia. Day +100 bone marrow demonstrated complete morphological and cytogenetic remission. At the time, whole blood and T-cell compartment showed chimerism 91% and 16% donor respectively, necessitating two donor lymphocyte infusions with the CD3+ -cell dose reaching 5 × 10 6 /kg. Full donor chimerism was achieved as of * E. Nikolousis emelni@hotmail.com 1 Haematology and Stem Cell Transplantation Department Heart of England NHS Trust, Birmingham, United Kingdom 1234567890();,: 1234567890();,: