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Post-BMT chromosome abnormalities

Hi All,
Rio (now 16yrs) had BMT in June 2008 for CML. Has made good recovery in that he feels extremely well and is back at school etc. However, he is having DLIs for a low residual level of leukaemia, which started in April 2009. Bcr-abl is gradually coming down (last result 0.048). But there is a bit of slippage in chimerism result (in myeloid lineage????) to 92% donor. BMA study of 31 cells shows that none are Ph+, but 2 of the 31 have some chromosomal abnormalities - not the same as CML. Rio's Consultant has never seen this before and consulted with Prof Marks (adult CML specialist in Bristol I believe), who has seen it before but said he does not know what it signifies! It is not typical of accelerating CML though(phew). Will be having next BMA in Jan. They seem to be suggesting that the 2 abnormal cells inm the sample are from Rio's own 'old' marrow. So I am thinking that successful DLI should eradicate the old marrow and hence get rid of the abnormal cells. Does anyone know anything about this please?
Thanks
Kestrel

Dear Kestral.
how many DLI has Rio had so far.. do you know the number of donor lymphocytes in each? they usually escalate the number of cells in each infusion very gradually. I had 4 with 12 weeks between each one until 50 million donor lymphocytes in DLI 4 did the trick. I have not seen evidence of residual disease for nearly 3 years now.

I am sure the abnormal cells are likely to be from his old marrow, and it is good to get Dr.Marks' opinion too.
If you need to ask me questions on DLI go ahead... it's a fairly miraculous thing and is termed as immunotherapy. The donor's mature Lymphocytes (not the original stem cells he would have received during transplant) are the ones that kill the old CML cells. But gradual rises in each DLI are needed to guard against the possibility of grade 3/4 GVHD although some evidence of GVL (maybe a rash or other minor reaction) does indicate they are working their magic. Having said that I did not have any signs of GVHD at all but still got the benefit of GVL (graft versus leukaemia)

Best wishes,
Sandy

Hi Sandy,
Rio has had 2 DLIs so far and is due the 3rd in early Dec. I know the first dose was very very low. We haven't seen any GvHD, tho I would find a rash reassuring!! Apparently (I remember being told after the BMT) they have enough for 5 treatments. I will ask how many lymphocytes in each treatment next time we go.
Thanks for your reply. Its always good to hear from someone who has 'been there'.
Best wishes,
kestrel

Hi Kestral,

I know they like to see a rash or some evidence of low level GVHD which points to GVL ... but I never had any sign at all... by the 4th (I started with 2.5 million and ended with 50 million) I was beginning to wonder if anything was going to work.. but then the magic Zero. That was a great day, but it took over 1 year. I know he will get there ;o)

Sandy

Hi Kestrel

It was nice to hear how Rio is getting along. I know that you posted a short while ago and I meant to reply to you but never quite got there.

Anyway, I am glad that the PCR is slowly coming down. I am finding this post transplant period so frustrating; I thought it would be easier but it is just as hard.

I have only had one DLI, then I got other problems. My DLI was because I wasn't 100% donor cells - the DLI didn't work for many reasons. I remain mixed chimerism but PCR negative, I have been warned that this situation may not last.

My dose of DLI was very low, I would have to look in my book to see the exact number, I also had the cells manipulated to remove the CD8 cells, this reduces the chance of GVHD. I haven't had any GVHD so far as I am aware - just other issues.

Anyway, I hope that things continue to go well

Susan

Thanks for replies. For me as Rio's carer, this post-transplant period is harder in some ways than the transplant - but I do believe we will get there one day. We can only keep on keeping on in the meantime!
Good to hear from you Susan. I keep an eye on your website and do feel for you with your perplexing problems. Thinking of you.
kestrel