Not Good News – Another Transplant

5-26-2012

It has been several weeks since I have posted any information and several people have asked about my bother Paul’s condition.  This post is a bit tardy because I have been hoping that I could present some good news about a situation that is not constantly changing.  Unfortunately, I can do neither.

It seems that a fairly large percentage of those who receive a stem cell transplant as treatment for myelofibrosis experience a relapse of the condition.  The precise reasons for relapsing are not fully understood.  It seems to me – and I am not a doctor – that the recipient’s DNA wants to keep making the kind of blood it is programmed to produce, even though that blood is defective and even though the cells for producing that blood have supposedly been destroyed by chemotherapy.  The human body can do amazing things, though, including somehow resurrecting the destroyed cells.

After the transplant, Paul, like all stem cell recipients was living in a condition known as “chimerism.”  That means that the transplanted cells, which have different DNA from the cells in the rest of his body were coexisitng with those other cells.  As long as that coexistence was peaceful, he could lead a fairly normal and healthy life.  However, when his own cells decided they wanted to move back into the bone marrow, serious problems arose and there was a relapse.

Six months after the transplant, a bone marrow biopsy showed that more than 90% of Paul’s stem cells had the DNA of the transplanted cells, so the chimerism was good.  Two months later, that number had dropped to less than 60%, indicating that serious problems were developing.  It seems that when such a relapse occurs the preferred initial treatment is a procedure called a “donor lymphocyte infusion.”  That would entail the donor (me) donating additional lymphocyte cells which would then be infused into the recipient’s (Paul’s) blood.  The theory seems to be that these white blood cells would help his immune system attack what were essentially his own cells that were trying to settle back into his bone marrow.

The donor lymphocyte infusion was approved by Paul’s medical insurance company, but another complication arose before the procedure could be scheduled.  The most recent blood tests indicate that he may now be developing acute myeloid leukemia, which is a condition in which abnormal white blood cells accumulate in the bone marrow and interfere with the development of normal blood cells of all types.  Since the fibrous tissue accumulating in his bone marrow because of the resurgence of his own stem cells also seriously interferes with the production of normal blood cells, the acute myeloid leukemia is a very severe complication.

The treatment that now seems to be appropriate is chemotherapy to send the leukemia into remission followed by a second complete stem cell transplant.  Although I could be the donor once again, the doctors in Texas feel that there is a greater chance of success if another donor is used.  My other brother, Jim, is also a very good match, so he is going to serve as the donor in the new procedure.

A paper presented by a group of German and Israeli stem cell specialist at the December 2011 meeting of the American Society of Hematology concluded donor lymphocyte infusions and/or second stem cell transplants “are effective and well tolerated salvage approaches, which result in the majority of patients in long-term freedom from disease.”  (https://ash.confex.com/ash/2010/webprogram/Paper33003.html).  That is good news, and we hope such long-term freedom is the outcome here.

I will update the situation as more information is forthcoming.