MRD increase after SCT

Hi @kgneal. Welcome to Mayo Clinic Connect and to the BMT group! Happy to have you and your dad join us! There’s an ever growing number of us who have undergone the allogeneic stem cell transplant for our blood cancers. While it’s an amazing life altering event, giving us a second chance at life, there are always a few surprises that come along with it. So it’s helpful to be able to speak with others going through the same challenges.

Having increases in the MRD (measurable residual disease) means a small number of cancer cells are showing up in the testing following your dad’s BMT. Since he’s almost a year post transplant, that is raising the eyebrows of his transplant team. It’s not an ‘omg’ moment but one that bears further investigation. It looks like his team is already on it with the request to have your dad back at the clinic for evaluation.

The DLI (donor lymphocyte infusion) can be helpful in situations like this where the new immune system your dad acquired, needs a ‘booster’! The new immune system is doing what it can to fend off any cancer cells but it might need a little more oomph to put it up to full capacity. Doesn’t mean it’s failing, just that it needs some backup. ☺️

Here’s a link to a search in Connect for DLI discussions. Feel free to drop into any conversation to ask members such as @dwolden, whose husband had a DLI to bump up his Chimerism.

DLI search: https://connect.mayoclinic.org/search/

What are your dad’s chimera results? What led your dad to require a BMT?

@kgneal I am nearly one year post transplant too. I see my Oncologist Thursday to discuss a DLI. To answer your question, no, my MRD did not jump around. It went from negligible to .04. My Chimerism results changed a little. My Transplant Dr ordered a BMB which showed the MRD and the return of one of the mutations I previously had.

I feel fortunate to have an Oncologist who is dealing with this at an early stage. Since I am experiencing the same thing your Dad is, I will not minimize what he may be going through emotionally. MRD and possible relapse of the Cancer are very concerning. I was shocked because I had been doing so well. Also, DLI is not trivial. Be sure to ask your team what the success rate is and how overall survival rates are affected.

Relapse rates are still pretty high with transplants. My original Transplant Dr prepared me for the possibility, but since I was doing so well I did not expect a relapse.

I hope your dad and you get good news!

@loribmt
Lori - I’m kgneal’s mom. There were extra stem cells remaining after my husband’s transplant that Mayo said they would store. Can those be used if Mayo decides to do the DLI? Is that a procedure that can be scheduled fairly soon after the Bone Marrow Biopsy and consultation? Is DLI an outpatient procedure?

Thank you!

Hi @glgrady1015 My doctor also reserved cells from my BMT at Mayo-Rochester. I believe that was done in the event that if I needed a DLI, the cells would be available but I never used them.
Since I didn’t have that procedure done, I’m going to tag member @dwolden. Her husband had a DLI at Mayo-Rochester about 6 months after his SCT there. I’m sure she’ll be able to give a little rundown of the procedure for you and your husband. I would expect the procedures are the same at all of the Mayo campuses.

From reading through the reply by your daughter you have quite a trek to Phoenix from Oklahoma. So I can understand wanting to know how soon an appt could be scheduled for the DLI following the bone marrow biopsy (BMBX) to avoid a lengthy stay in Phoenix. Results from the bone marrow biopsies can take a week to 10 days, even at Mayo where results for other tests are usual immediate. But there are several parts to the BMBX which can take several days. However, the blood work might be enough to give the your husband’s transplant doctor a direction as to whether the DLI is required or not.

It’s perfectly ok to ask questions of the BMT team on the portal. At least from my experience, questions regarding my health were always answered quickly. So don’t hesitate to ask his doctor or team what the schedule may look like ahead so you can plan. Mayo is notoriously very accommodating and respectful of patient time and travel needs.

Do you fly into Phoenix or travel by car?

@loribmt thanks for your reply.
Right now we’re planning to fly but that could change depending on length of stay needed. The transplant dr. was out all last week so I have a call and portal message into him. We hope to hear back soon in order to make plans.

@glgrady1015 it can be assumed the “extra” cells were saved just in case a DLI was needed.
My husband needed a DLI six months after transplant due to incomplete chimerism. There were no cells left over after transplant so our anonymous donor was very kind and donated again. What a blessing.
The DLI was a tiny amount of material and was done quickly as an outpatient procedure, but we did need to come back the next day to get bloodwork and see his transplant doc.
The DLI was successful and he achieved complete chimerism within two months. He did develop some GVHD at that point, but it was closely monitored and well managed by the team.
Best of luck to you and your husband. Every day is a wonder for us, and may you have many many good ones ahead.

@dwolden thank you for the response and I’m glad to hear your husband is doing well.