Hi looking for some advice from anyone who has experience of dropping chimerism 3/4 years post transplant?.
My daughter had a BMT to treat refractory ALL in 2017. Although her bone marrow always been a bit fragile. Mild pancytopenia and only 40% graft marrow cellarity. She always had 100% chimerism until about 18 months ago. It started only in the myeloid cell lineage and has been dropping very slowly but dropping nonetheless. She's now at 82% donor,18% self chimerism for myeloid.
But now the lymphoid is dropping too sitting at 97% last check.
We were told DLI isn't an option as it was myeloid that dropped first.
Trouble is now my daughter has said she doesn't want it checked anymore, doesn't go to appointments and doesn't want to know . I've tried to intervene but she's 21 now so I have no authority. I'm pretty terrified.
I'm worried about cancer obviously but my immediate concern is that her donor marrow is O neg, O neg cells don't react but they make anti a and anti b antibodies in plasma right????
Her retuning marrow will be making A+ blood cells. So there will come a point when there will be across reaction if myeloid continues to drop, the anti A antibodies in plasma will go for her A+ blood cells??
Without seeing her consultants I can't ask and she doesn't want to know??
How can this be treated? Does anyone have experience ????