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HLA typing : SCT

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Hi all,

I got my HLA typing report with my sibling as Donor.

The report shows 6/10 match. Is this an good match for sct?

Hello.  I'm sorry I do not know about typing.  Is this precautionary and have you exhausted all TKI options?  I browsed through your posts and could not see any that mentioned FISH or PCR results other than one saying you did not hit the 3 month target.  I would definitely get a couple expert opinions before proceeding to SCT.  There are of course people with a lot of experience on this site that can provide a comparison to their own walk/decisions.  Praying for your success and I'm glad that you have an option should you need to go that route.

Hi Job,

Yes, its precautionary. Wanted to check if my sister is a match.

Report shows 6/10 matched. Not sure what it means. Good or bad!

I am on tasigna since 1st Jan 2019, have scheduled for my first PCR april 1st.

I got my bone marrow slides reviews at another famous hosipital. They gave my blast% as 8% and as CML-CP. However my current hosiptal gave my blast% as 12% and as CML-AP.

Dont understand which one to trust:-)

Hi David/Sandy/Scuba. Appreciate your inputs

I am no expert in HLA matching. I know that there is a 1/4 chance of a sibling being a full HLA match (my sister is, I am fortunate). 

HLA matching is pretty complicated. Testing is usually based on 8 or 10 markers, so I imagine in your case this was 6/10. Bethematch.org suggests you want 6 of 8 for a good transplant but the more the better.

This document gives a reasonably readable discussion of the best, next best HLA donors but even then isn't that easy to read. It's a very complicated subject, and making it easy to understand as "6 out of 10" belies the complexity underneath.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4272893/pdf/nihms632201.pdf

An interesting aside, an identical twin isn't actually a very good match for their twin. Their marrow is too similar.

David.

Thanks David. I understand it is pretty complex subject.

Another doubt - I had, i got my Bone marrow slides reviewed at other hospital. The report shows mine as CML-CP (8% BLAST). However my current hoapital stated i am in CML-AP (12% blast).

I am on tasigna 800 mg, since 1st jan. Can i move back to Imatinib?

I am yet to havr my first PCR.

Davids reference on HLA is good and explains it very well.

Given your blast percentage (borderline AP), you should consider switching to dasatinib right away. Nilotinib (tasigna) works similar to imatinib (gleevec), just a tighter binding to the ATP socket. So imatinib is likely to work less well for you than nilotinib is currently. Getting blasts under control has had success with dasatinib. It works very differently than imatinib or nilotinib and attacks higher order cells (which imatinib does not).

Also - make sure your blood vitamin D level is above 50 ng/ml (but below 100 ng/ml). If you have very low vitamin D (< 25 ng/ml), your blast cells are not getting the signal to differentiate. Research has shown that leukemic blast cells can differentiate (out of existence) when proper amount of vitamin D is present. It's not guaranteed, but it helps.

I was borderline AP as well with about 8% blasts. Imatinib did nothing to reduce my blast cell burden. Only when I switched to dasatinib coupled with getting my vitamin D level elevated did my blast cell count fall quickly and is now zero and has been for years. Normal blast cells appear and differentiate into daughter cells very fast. They need vitamin D to do it.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725501/