[JasonG1972]

I have a question for the group. After receiving Vidaza for Myeodysplasia, my father relapsed to AML. Then, his first induction chemotherapy failed. Though his doctor described it as a "hail mary,", the salvage regimen of FLAG was brought his blasts down enough to have a stem cell transplant.

Now, 8 months post transplant, he has relapsed again (AML), and it's progressing rapidly (80% blasts)

As I understand it, we have a two options (assuming we are shooting for another transplant).

1. Try the MEC regimen -- It's the natural next salvage course. I know, however, that this is likely to really kick his butt, as he's already quite weak. I'm worried he won't survive it.

2. Repeat the FLAG regimen which got him into a sustainable enough remission for the SCT. His doctor is open to this idea.

Here's my question, and it's related to the role of the donor stem cells, engraftment, and the power of a new immune system against leukemic cells.

If FLAG (or MEC) works enough -- and that's a big if -- there will likely still be some leukemic cells remaining. I believe he relapsed from his recent transplant due to a lack of immune response. He experienced very little GVHD, so the mutant drug tolerant cells were able to proliferate (unrelated 9/10 donor, by the way).

What IS the power of GVHD in killing/thwarting the remaining disease. Can it (the donors immune system, essentially) do what the chemo couldn't. Can it finish the job against these final stubborn cells?

I have what I like to call pigeon knowledge of all this, so I hope my question makes sense. Please let me know if I can clarify anything. And, of course, thank you in advance for your thoughts.