BMT Failure For MDS

[RachelsDad]

So I'm new to all of this but my dad found out a few years ago he had Multiple Myeloma and went through treatment with Chemo and a STP with his own stem cells. After a few check ups he found out that he now has Meylodisplasia so they decided to go with a STP from a donor. This was a very good match considering he has no direct siblings.
His platelet count went up quite a bit and on day 14 His chimerism (spelling? ) test came back at 22% (his donor's stemming cells took over well). Then on day 30 the chimerism test came back 92% (I usually doesn't go up to the 90s until day 90 or so) which was amazing. Now at day 60 the test came back at 42% and his platelets dropped even more. He went with a bone marrow biopsy to find out if he still has MDS, which the doctor said yes and that the BMT did not work. Has anyone else experienced this? If so, what were your other options?
He is a very healthy 51 year old and now he meets with the doctor tomorrow to find out what he had to say. This doctor is a specialist for Multiple Myeloma but has been speaking with the MDS specialist at Hershey to verify what he is doing is all good. We don't know if he will need to go find a doctor with more experience or not. I'm just curious as to what my family is in for.

[Whizbang]

Rachel,

I believe that if the MDS shows as back, they 'might' do a very strong dose of Vidaza for 7 days and then a DLI (donor lymphocyte infusion)...

I was going to receive the above, until they realized I had transformed to RBC Leukemia...

hate to quote Wiki: "One strategy of managing relapse, donor leukocyte infusion, might eliminate the need for a second BMT in some patients."

I'm D19 after the start of my chemo, and my erythroblast's were 70-80% before hand, now as of last Monday's BMB, they were <10% and still falling... So a very successful result...

Don't give up hope, there are a lot of things they can still do, I too am going for a second transplant around August 31st...

All the best to you and your Dad, and may God Bless us ALL!!!

[RachelsDad]

Thanks for everything you have said and explained. I hope it all goes well for you! I still haven't heard what his doctor said but he said he does have a few options he is thinking about. My dad is getting very scared right now so I know all I can do is be there for him.
However, a family member of ours called into the American Cancer society and they called my dad and agreed to take him to Philadelphia or Chicago to get tests done for 3 days. On the third day he will sit in front of a board of Oncologists who will decide what route to take. I won't know more until later tonight about what his doctor said but right now he is asking my brother to come home from Pittsburgh and my step mom is taking this week off work. So something must be going on.

[sbk007]

Sorry you have to go through all this. Your Dads been fighting a while.
Its hard to speculate what the doctors are thinking without knowing what tests he's going for. Usually Doctors follow a flow chart. In general if the relapse occurs less than 6 months after the 1st transplant they won't try another transplant and treat it supportively. I read that MM patients have a high incident of secondary hematologic malignancies so I wonder if the MDS was a result of his past treatments for the MM. They can try what Whizbang mentioned and that is to contact the donor get more stem cells and infuse them without any chemo or conditioning before hand to fix the chimerism.
I wish you and your family the best.

[RachelsDad]

Thank you and I did find out today that what they are going to do is start to take him off the anti-rejection meds. He is currently on 2 of them, one that lasts three days and one thay lasts a week in his system. They pulled him off the three day meds today and a week from now they will take him off of the other meds.

With this happening, they hope to see his platelet counts going up which means that his body is taking in the donor's stem cells. If the platelets do not go up 2 weeks after removing the anti-rejection meds then they will give him a booster shot of the donor's cells in hopes that his body will accept them without the meds.

When they remove each anti-rejection meds they hope to see a little bit of graft vs host. They don't want this to get too bad and go to the liver but if he gets it in a mild form and he can fight it off then that's great. Its just a very tricky process and I know that if he doesn't get over the graft vs host then that only leads to bad things.

So I do hope this is the way to go but he is waiting for another second opinion to make sure they would do the same. I want to thank everyone for your opinions and I am always looking for more opinions and hearing about other patient's stories. I do appreciate all of you thinking about my dad and keeping him in your thoughts! Lets hope he gets better soon! Time to be positive!