@tlsorbet There is a very fine line between having just enough and too much immunosuppression to control GVHD. We do need some graft vs host, or in our case, graft vs leukemic reaction. That is the whole premise behind the bone marrow transplant in the first place. To use the natural cancer fighting cells that come with the newly acquired immune system.

But when we first get the new stem cells from our donor, they are very aggressive and not only want to take out other cancer cells. They also fight against the normal proteins in our body (the host). When that happens unrestricted, the graft will attack our bodies.

Newer protocols in the past several years give another, preemptive GVHD medication at the time of transplant. This is used to help lower the risk of serious GVHD reactions. It isn’t meant to control a GVHD response 100%. We need some of that response. Though it works so well, some people may not even realize GVHD (or GVL graft vs leukemia) is happening behind the scenes. This protocol wasn’t standard 7 years ago when I had my transplant, so it’s been a great advancement for BMT patients.

If there is a mixed chimerism, it isn’t unusual for the transplant doctor to then lower the level of immunosuppression. This allows for the new immune system to become a little more aggressive. This adjustment is often enough to nudge the production of more cells to push out any remaining cancer cells and naturally upping the chimerism.

There is also such a thing as a DLI. Donor Lymphocyte Infusion. White blood cells are collected from your donor and infused into your system again. This treatment has been shown to be helpful in bumping up a chimerism and also in preventing or treating a relapse. (It’s not another transplant. Just a blood transfusion of white blood cells)

As a BMT patient at Mayo Rochester, I highly recommend you have a consult with their transplant department. From conversations I’ve had with my team, they often get patients in from other clinics where followups are sparse or patients are not happy with their post transplant results. I know patients who have been able to get help through tele-visits. Might be worth a try for you. Here is a link to the Mayo patient request page to get you started.
http://mayocl.in/1mtmR63
Is your chimerism still mixed?