Conditioning Regimen/Chronic GVHD correlation?

[mausmish]

I saw my oncologist at University of Maryland today and discussed the consultation I had in Seattle, including some clinical trials I'm considering. She suggested that, in addition to trying to determine what studies might offer the most promise for long term relapse-free survivability, I should inquire about incidence and severity of chronic GVHD for study participants for the various pre-transplant conditioning regimens (i.e., different types, doses, and combinations of chemo, radiation, etc.).

I'm looking at the usual resources and references and also searching the web for relevant studies, but I also wondered if anyone here could offer insights regarding chronic gvhd, either from personal experience or in discussions with their own medical professionals.

Thanks for any info!

Karen

[Laura]

Yes, she was very correct. The three main things that I learned were important to ask about were survival rates, rate of GVHD, and rate of rejection. Transplants for AA have high rejection and GVHD rates. That is one of the reasons why I did a trial that my hospital had. They have found if you use Campath instead of ATG it reduces the risk of rejection and GVHD. I decided to do the trial and I am so very thankful I did. If I would go back in time, I would do it all over again. I received Campath, Cytoxan, and Radiation for my conditioning. I also used Prograf instead of CSA.

Laura

[mausmish]

Thanks, Laura! That's very helpful.

[squirrellypoo]

I don't know about studies so all I can tell you is my experience:

I had a Reduced Intensity Conditioning (RIC, ie: "mini-transplant") Matched Unrelated Donor (MUD) Stem Cell Transplant (SCT). My donor was a 9 out of 10 match.

My conditioning was Busulfan, Fludarabine, and Campath (no radiation).

I was on Cyclosporin for only 2 months post transplant (this is rare. Normally it's 6mo-1yr).

The only GVH I experienced was of the skin (an itchy, hive-like rash a month or so post-transplant before stopping the Cyclosporin, and this responded well to topical ointments, and then I had a few isolated patches of eczema until about 6 months post transplant), and clinically this was classed as "extremely mild".

(This makes it sound like my transplant experience was all sunshine, rainbows, and gumdrops - it wasn't. But you just asked about GVH so I'm not going into detail about my meningitis, liver and lung infections, blood pressure problems, etc!)

[starz]

Nicks conditioning was the same as Squirrellypoo. Although there was a 20 yr age difference and he had CMML. Also a 9/10 MUD. He had minor skin GVHD after 1 month, had a reaction to Ciclosporin and had the dose reduced quickly. The skin rash then spread all over but is responding to topical steroid cream. Nearly gone now at about 80 days post.

[Greg H]

Originally Posted by squirrellypoo

(This makes it sound like my transplant experience was all sunshine, rainbows, and gumdrops - it wasn't. But you just asked about GVH so I'm not going into detail about my meningitis, liver and lung infections, blood pressure problems, etc!)

Hey Squirrellypoo!

My doc has recommended an RIC and I'm very interested in hearing about other folks' experiences. Tell me about all that icky stuff, if you don't mind. All transplant related?

Thanks!

Greg

[Greg H]

Hey Squirrellypoo!

I found the great thread with all your post-transplant posts. Thanks much for posting all that as it happened. It's a fascinating read for someone contemplating transplant.

Thanks!

Greg