Anyone go through duv/romi treatment before an allogenic BMT?

Posted by alxlo1 @alxlo1, Jan 19 12:01pm

Anyone going through duv/romi treatment before an allogenic bone marrow transplant. What were the worst side effects and outcome.

Interested in more discussions like this? Go to the Bone Marrow Transplant (BMT) & CAR-T Cell Therapy Support Group.

Lori, Volunteer Mentor | @loribmt | Aug 25 9:18am

In reply to @alxlo1 "@loribmt 144 days post transplant, flow cytometry of lung fluid shows an atypical CD4 positive population..." + (show)

Hi @alxlo1 Well, that’s not the news you wanted to hear. But since you’re still relatively ‘young’ in your BMT recovery, there might be a couple of rabbits your doctor can pull out of the hat to ramp up your response to the lymphoma cells.

The goal of the bone marrow transplant would be for your new immune system to recognize the cancer cells and snuff them out. That is the beauty of the ‘graft vs host’ or graft vs leukemia/lymphoma effect of the transplant.
If you’re still taking immunosuppressants/anti-rejection meds such as tacrolimus, your doctor may make adjustments to that medication as well. By lowering the tacro dosage and allowing the new cells to respond more aggressively that may help your body fight any new cancer cells.

If you’re already off the tacro then occasionally the BMT needs a boost with another infusion of lymphocytes from your donor. It’s called a DLI (Donor lymphocyte infusion). This can help leverage the immune response of the donor's cells.

What has your doctor discussed with you as a followup treatment?

alxlo1 | @alxlo1 | Aug 25 10:00am

In reply to @loribmt "Hi @alxlo1 Well, that’s not the news you wanted to hear. But since you’re still relatively..." + (show)

@loribmt tapering off cyclosporine this week, then sirolimus next week. Thanks for the info about DLI, I'll discuss with the doctors

Lori, Volunteer Mentor | @loribmt | Aug 25 12:23pm

In reply to @alxlo1 "@loribmt tapering off cyclosporine this week, then sirolimus next week. Thanks for the info about DLI,..." + (show)

@alxlo1 These are two of the topics that came to mind. DLI or reducing the immunosuppressants if there is the possibility of boosting the impact of the transplant…if that would help with your situation. Keeping in mind I’m not a doctor so I may be way off base in this case. I know both ‘treatments’ have helped, personally in my own experience, and from shared information with conversations I’ve had with my transplant doctor and fellow BMT people.

It’s obviously important to guard against graft vs host disease. But we do need the benefits of this side effect of an allogenic stem cell transplant. Cyclosporin has been added to transplant protocol to help reduce the possibility of more aggressive side effects of gvhd. There is a fine line between ‘finding the sweet spot’ with too much suppression or just the right amount. Since no two people are alike it can take some tweaking. This was from the discussion I’ve had with my own transplant doctor at Mayo. Wishing you well on your journey. Will you keep me updated please?

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