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My husband has MDS and PNH. He has an allo SCT in February and is generally doing well, but currently has some issues with chimerism.
His myeloid line (problematic before transplant with transfusion dependency in platelets and HB) now has 100% chimerism (and low normal range blood counts throughout) but the lymphoid line is only 64%. He has had one DLI which has had no effect - another is expected in a few week's time.
Please can you explain to me
a) how the two lines can have such different donor/host mixes?
b) if his lymphoid line remained at 64% donor, what are the implications of this (I know disease relapse is more likely with low T cells). If his lymphoid line was ok pre transplant, would a higher mixed chimerism in this area be more acceptable?
Thanks you your question. It is very common to have a mixed chimerism post transplant especially so early on in the recovery stage, even if the patient is in remission. Each bag of stem cells transplanted has differing amounts of cells and the body uses them at different rates, hence the different mixes in the lines.
The purpose of the DLI is to ensure all the marrow cells come from the donor. Further doses can be given at three monthly intervals. Sometimes several doses of donor lymphocytes are given until the desired effect is reached and the chimerism is increased.
Hope this helps.
Caroline - Macmillan Information Nurse Specialist
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