Failed Transplant/Relapse of MDS

[sandra4611]

My husband is facing DLI for relapse/failure of transplant. He is at day+90. Chimerism was 88% at day 28, 93% at day 56, and his most recent test from day 80 is still 93%. His sister was a 10/10 match and although he was late to engraft (first signs at day +21) he has had no side effects from the transplant. Due to the reduced intensity conditioning (he is 68) he developed mucositis in the second week but it only lasted two days. Otherwise it's been smooth sailing...until six weeks ago. All his counts were in the low normal range and then his platelets dropped 20 points. The next week they were down another 20 points. Doc stopped Bactrim (Septra) antibiotic since that can affect platelet count. No change, kept falling. Doc reduced Tacrolimus, kept falling. Doc stopped Tacrolimus altogether. Another drop. Mike has gone from 149 to 43 in six weeks. Doc did a bone marrow biopsy. Blasts are 7% - same as before transplant. We don't know if it was 0% and then rose back to 7% or if it never went down at all. Hemoglobin has stayed at 13.8 -14.0 but just this week, his white count dropped down to 2.4 - a full point. Biopsy shows no Y chromosomes, which is good, and no new chromosome damage, also good. Doc says we can't really call it a complete failure because it did "fix" the red blood cells, his most affected cell line. But with mixed chimerism & blast count, it could be a relapse. Guess it doesn't matter. He's still got MDS and the doc says he is likely to develop AML soon. He is starting my husband on Vidaza for one month and then will add DLI for 5 days along with the second month of chemo. Mike was on Vidaza for 13 rounds before transplant and did fine. No side effects. The literature says DLI is not likely to work and his outlook is poor.

[bailie]

Welcome to the forum Sandra.

5-azacytidine as salvage treatment in relapsed myeloid tumors after allogeneic bone marrow transplantation

Abstract

"Current strategies for management that include donor lymphocyte infusions (DLIs) and salvage chemotherapies are usually toxic and ineffective. Here we report the outcome of 10 patients with myeloid malignancies that received 5-azacytidine after a failed allogeneic bone marrow transplant. Of the 10 patients, 6 achieved a complete remission, 1 had stable disease, and 3 progressed after a median of 6 cycles administered. Only 1 patient has died (of disease progression), and no flares of graft-versus-host disease (GVHD) were observed with 5-azacytidine. As of latest follow-up, the median overall survival (OS) for the group was 422.5 days (127-1411). These results further suggest that 5-azacytidine is an active agent after failing an allogeneic bone marrow transplant, and prospective studies are warranted."

[bailie]

Your doctors are likely to be following this:

Combination Of Vidaza And Donor Lymphocyte Infusions Shows Promise In Relapsed MDS Patients (ASH 2011)

By Jessica Langholtz
Published: Dec 19, 2011 3:14 pm

Combination Of Vidaza And Donor Lymphocyte Infusions Shows Promise In Relapsed MDS Patients (ASH 2011)
A treatment combining Vidaza and infusions of donor white blood cells may be effective in myelodysplastic syndromes patients who relapse after stem cell transplantation, according to results of a small Phase 2 clinical trial conducted in Germany.

In addition, the study authors found that patients who had a complete response to the combination therapy experienced significantly longer overall survival than those who did not.

Dr. Thomas Schroeder of Heinrich Heine University in Duesseldorf, Germany, presented the clinical trial findings at the 2011 American Society of Hematology (ASH) conference in San Diego last week.

In patients with myelodysplastic syndromes (MDS), relapse after stem cell transplantation is associated with a poor disease prognosis.

Previous research has shown that MDS and acute myeloid leukemia (AML) patients who relapse after transplant often respond to treatment with Vidaza (azacitidine).

Some retrospective studies also have shown encouraging results for combination therapy involving Vidaza and donor lymphocyte infusion.

Donor lymphocyte infusion, often abbreviated DLI, is a procedure in which a stem cell transplant patient receives an infusion of donated white blood cells. The cells usually are donated by the original stem cell transplant donor.

In the present study, German researchers evaluated the efficacy and safety of Vidaza and donor lymphocyte infusion in MDS and AML patients. The combination therapy was used as a salvage therapy after the patients relapsed following transplantation.

Of the 30 patients included in the study, 92 percent had AML and 8 percent had MDS. At a median of 160 days after transplant, all patients experienced relapse.

Patients received 100 mg/m2 of Vidaza daily on days 1 through 5 of a 28-day treatment cycle followed by donor lymphocyte infusion after every second treatment cycle.

Patients received a median of three treatment courses of Vidaza, and 73 percent of patients received a donor lymphocyte infusion, with a median of one infusion.

Overall, 47 percent of the patients responded to the treatment, with 23 percent achieving a complete response and 7 percent achieving a partial response. Of the patients who achieved a complete response, 71 percent maintained long-term complete response (median of 605 days) without any additional therapies.

At a median follow-up period of 645 days, 17 percent of the patients are still alive. The median overall survival time is 117 days. Patients who achieved a complete response to the trial regimen had significantly longer survival times than those who did not (not yet reached versus 83 days).

The primary causes of death were progressive disease (40 percent), infection (13 percent), and bleeding (7 percent). Five patients underwent a second stem cell transplant, but all have died.

Graft-versus-host disease, a common transplant-related complication in which the donor immune cells recognize the recipient’s cells as foreign and attack them, occurred in 42 percent of patients (37 percent acute, 5 percent chronic).

All patients in the trial experienced serious to life-threatening low blood cell counts, but only 37 percent were considered to be treatment-related. Other common side effects included infection and bleeding.

For more information, please see abstract 656 at the ASH 2011 meeting website.

[Shikha tomar]

My mothers mds relapsed and as dr. Suggested she had alloHsct 6/6 Match..on aug-2015
after transplant she recovered platelet but her hb was always around 6-7,,,now she has irritation in her eyes and sore throat + Thrombocytopenia (platelet count=29,000)
her biopsy report shows insufficient stem cells...shes on cyclosporin and many more drugs.
dr.'s have no idea whats the reason behind it but as i was going through so many articles i found one which says irritation in eyes is related to cgvhd and that thrombocytopenia thing is may be because of secondary failure of platelet recovery.
please anyone here who had similar problem
what kind of treatments are available for such problem. I want to know more about this SFPR thing.,
please somebody help!




----------------------------
MDS relapse allohsct performed on 18-aug-2015, 18% Blasts Had mild gvhd ,
+317day , low platelet count 29,000
lowTLC..irritation in eyes and sore throat! ( Mild cgvhd)
prescription
Acivir
Cyclosporin
Pentids
Bactrim
and now Revolade because of low platelet counts
chimerism 100% donor
BMB is fine but has insufficient cells

[JanetB]

Sandy,
How is your husband? Mine appears to be relapsing 24 months post transplant.
His platelets are down to 42k from a high of 180k. His doctor suggested a DLI but has now said he'll do a BMB and a full transplant if the MDS has returned.
Hope you two are well.