Mixed chimerism after BMT for AA anyone?

[AAMarge]

My daughter had a BMT for AA in August of 2010-sibling donor. Things went well & she's been doing great with normal counts. Until January 2013. Platelets down as far as 26 & we are basically in transplant rescue mode-after 2.5 years! We have known that she ended up with mixed chimerism (donor cells plus her original cells both present). It had been stable since transplant, but now shows an increase in her cells. As her cells go up, counts go down.

Currently trying Prograf (couldn't tolerate cyclosporine), which has stopped the freefall, but has not increased her counts.

I know AA pts can have mixed chimerism because of the "gentler" conditioning. Anyone out there with any experience with mixed chimerism causing late problems? Results?

[Cam]

I don't have any experience with that form of Chimerism. But I am currently on Prograf for GVHD. I was on cyclosporine before. Prograf will suppress your Hemoglobin so be prepared for that. It will also give you loose stool. So be prepared for that.... I am about to be weaned off it. I can not wait for that issue to disappear.

[AAMarge]

For anyone happening upon this thread later, an update: Mixed chimerism was the undoing of my daughter's BMT. "Something" (we will never know what) riled up her immune system, and her original cells spent 2013 in a repeat of 2010....slowly destroying her bone marrow. Her cells won, and her sister's cells lost.

She was retransplanted in Nov 2013 with the same sibling donor, but a harsher conditioning to destroy more recipient cells. A few bumps in the road, but moving along in her recovery. It was a little surreal to repeat the whole business, but the writing was on the wall.

[Whizbang]

AAMarge,

I had the harshest conditioning possible (including TBI), due to my high risk MDS and terrible cytogenetics... It was quite impossible for me to revert due to chimerism, yet 8 months after my transplant my MDS transformed to RBC leukemia, still 100% donor...

I'm 23 days out from my (7+3) chemo, waiting for my counts to come back, and moving forward with the same sibling donor also... I agree it's crazy going through a 2nd Transplant (scheduled for 8/31/14), the Brightside being - knowing what to expect... And the fact that we were lucky enough to be able to handle and have a second transplant...

I wish you and your daughter continued success, and a permanent remission...

All the Best, and may God Bless us ALL!!!
David