DLI - not so good news?

[Guest guest]

Hello everyone

Yesterday Prof Mackinnon examined my wife at the Royal Free.

The results of the previous weeks tests had come in and showed the chimerism was still mixed and the FLO cytrometry showed there was still some CLL, slightly more than the test 3 months post SCT.

In the result 3 months post SCT before we left in February, the MRD was positive for the CLL and the chimerism showed neutrophils 100% and the T cells and B cells were mixed.

What I understand is that the stem cells given are depleted of the T cells and that these either develop themselves or then the T cells have to be given bythe donor again.

Can any one throw some light on all this?

Any way they had frozen the Lymphocytes from her sister in january and are planning to give them now.

But the problem is that she is on prednisolone for the Wells cellulitis she developed on the skin that was diagnosed in Delhi.

Prof Mackinnon said that the prednisolone would negate the DLI .

We had brought the blocks of the skin biopsy with the reports and now they want to get them analyzed here and then decide with the dermatologist here if the prednisolone can be tapered off and replaced with something else so they can give the DLI.

It seems this has to be done as soon as possible so that the CLL does not increase and can be dealt with by the DLI infusion.

I had asked why the CLL can not be treated with a shot of Ofatumumab or something but he said the level of the CLL does not warrant that.

The eye ofcourse no one knows what to do about. We went to see the eye surgeon who had done the vitriectomy here and he said it seems to be better but could give no further inputs about it. He said the doctors in India seem to be doing the right thing.

Any way he sent us to another doctor for a second opinion who examined her and said the same thing. The doctors in India had advised we carry the gancyclovir with us and get another injection while we are in London and he said he said he would give it but it is the worst intravitreal injection she has ever had, He burst a blood vesel and used a thicker needle said he didnt have the fine one- we assumed he knew what he was doing - wrong decision- should have said no thank you and gone back to the doctor who had done her operation .

Just shows you have to be vigilant about doctors all the time.

Prof Mackinnon said it does not make sense in giving gancyclovir in the eye when she was CMV negative in all the tests, but that the eye doctor would know best.

So now he will tell us in a few days about what they plan but from what it seems now we will have to go back to Delhi as planned next week, then taper off the steriods and come back in a month or so for the DLI

Any inputs on all this will be very welcome.

Best wishes and good health to all.

from DelhiWife diagnosed with CLL in 1997 at age 44,Fish del 13q, unmutated, Zap 70 positive2001 : Chlorambucil partial remmission2002 : RF 6 cycle . Acheived CR.

Relapsed 2004.Feb 2008 - Oct 2008 : RFCcycle 1,2 FC, cycle 4 to 6 RFC cycle 7 Rituximab , cycle 8 RituximabRelapsed March 2009 - lymph nodes in abdomen, axilla and neck .Diagnosis changed to Non Hodgekins Lymphoma - CLL / SLL

Previously it was only CLL.AIHA in May 2009, resolved with prednisolone .Remission after Ofatumumab 8 cycles of 2000 mg given 13th August to 8th October5th Nov 2009 Mini SCT at Royal Free in London under Prof Mackinnon, donor is sister.Post transplant 6 months 4 weeks doing well dispite the hiccups .