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Bone marrow biopsy clean post transplant but lymph nodes not, confused

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#1 JasmineT


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Posted 30 December 2011 - 08:17 PM

Hello everyone.  I have a cousin who has leukemia (CML).  She was diagnoselast year and quickly became very sick.  She found a one marrow transplant donor.  Her bone marrow now comes up clean but it sounds like it's now in her lymph nodes.  She is over 100 days post transplant.  It sounds like they want to take her off some of her other meeds and put her back on gleevec with a double dose.  I think they may also wish to use some of the donors cells to try to fight it, although it does not sound like it's the same procedure as a bone marrow transplant.  I am very confused as to why her bone marrow is clear butbher lymph odes are not.

I find it very difficult to find information about this on the Internet.  What I can find is filled with medical terms I often don't understand to tell the truth.  I am hoping that maybe someone could help me and provide or point me to some information on this that may help?  I am very worried and any help would be appreciated.

#2 Trey


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Posted 03 January 2012 - 02:52 PM

The bone marrow biopsy (BMB) will not show lower levels of leukemia.  A PCR test is required to show that.  So at least your cousin does not have leukemia roaring back.  That makes me wonder if the lymph node issue might instead be from a secondary infection.

The procedure the docs are going to use is called a Donor Leukocyte Infusion (DLI), where they will take lymphocytes (T-cells, etc) from the original stem cell donor and put them into your cousin's blood.  This can sometimes help the body fight the leukemia if it returns after transplant.  The reasons for the return of the leukemia are two-fold: 1) the chemo/radiation did not wipe out all the leukemic stem cells before transplant, and 2) the post--transplant graft vs leukemia effect did not work well enough. 

The swollen lymph nodes are not the problem by itself.  If it shows a return of the leukemia, then that is obviously not a good thing.  But it could be a secondary infection instead.  I hope the docs have sorted this out first.  Assuming they have determined the leukemia has returned, then having your cousin take a CML drug is necessary.  In fact, CML transplant patients are often put on CML drugs even if there is no sign of leukemia, and the DLI is also a good idea.  So it sounds like the docs are doing the right things.

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#3 JasmineT


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Posted 03 January 2012 - 06:11 PM

Thank you Trey.  I can't tell you how much your kindness means to me.

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