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Chimerism

Hello there, first time posting but have used this forum several times in the past and found it very helpful. Looking for other patient’s experiences of reducing Chimerism after transplant. My 15 year old son had his transplant in January for refractory T cell ALL. Initially (day 33) his peripheral blood chimerism was 100% donor, this has dropped to 90% at day 118, T cells 100% donor. His only bone marrow was at 69 days and was 94% donor (97% T cells). I’m really worried that this leaves him vulnerable to relapse. The medical team plan to do a CD34 lymphocyte ‘boost’ from his donor. Just wondering if anyone has had a similar experience and what the outcome was. I like to be prepared for the worst so appreciate good and poor outcome experiences.

Comments

  • Hello
    I am the lead nurse in patient services, thanks for posting. After a transplant chimerism can fluctuate a little bit especially in the in early period as the new immune system is growing. As your son had his transplant in January this would still be considered the early phase of recovery so this is normal. There is a risk of relapse but that is when the chimerism is much lower and without any treatment. Your sons medical team are treating this early to ensure this doesn't happen. There are some patients that never quite make 100% chimerism and still remain in remission. The 'boost' that is being planned is called a donor lymphocyte infusion (DLI) and is a very normal treatment to have in this situation after transplant. There is information in DLI on our website that you might find useful https://www.anthonynolan.org/patients-and-families/recovery-body/having-donor-lymphocyte-infusion-dli

    After the DLI the medical team will continue to monitor his chimerism which can take a few months to respond. Depending on how he responds it might also take more than one DLI, this would be nothing to worry about and again is normal. The main side effect is GvHD which will be monitored closely and discussed with you if and when it happens. Remember GvHD is not a bad reaction and could actually help push the chimerism up.

    I am sure there are people on the forum who have experienced similar and will be willing to share and hopefully they will post soon. If you have any question please get in touch our number is 0303 303 0303.

    Thanks
    Hayley

  • Hi. I can entirely understand why this might seem worrying but perhaps my experience might help.
    I had my transplant in March 2014 and everything went well apart from the fact my chimerism was stuck at about 35%. I had two DLIs in September and December 2014. The process is really simple it’s just a canula, if you don’t have a Hickman line, and it takes just a couple of minutes.
    After the first it went up to about 50% and after the second to 99% to be shortly followed by 100%. I was lucky not to have any GvHD and been well ever since.
    I’m very conscious that not everyone is so lucky but I hope your son is.

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