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Dr. Indranil XXXXXXX 21 July 2019 Dear Dr XXXXXXX I
Question: Dr. Indranil XXXXXXX
21 July 2019
Dear Dr XXXXXXX
I have sought your advice four years ago regarding my niece’s aplastic anemia, and thanks much for your avice in the thread
https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=210833
My niece has increased eltrombopag to 125 mg in 2015 but no notable improvement. She received 2nd ATG (rabbit) in late 2017 but no response. Her conditions keep declining and is now receiving platelet transfusion once every week, RBC transfusion about once every two or three weeks, also has neupogen injection once every week. Has received over 150 bags RBC and over 150 bags platelets since she has transfusion need.
She will need to do bone marrow transplant. She has no sibling match, and found a 10/10 match but unfortunately the potential donor refused to donate. Her best match found now is 9/10, with one allele mismatch at DRB1. Doctor said it is not perfect match but could still proceed to transplant, but she could not tell the chance of success for a 9/10 match as compared to 10/10 match. Given my niece’s serious conditions now and that we have already initiated donor search since October last year, we reckon that the chance of finding another 10/10 match is slim. We therefore have decided to proceed to BMT. Yet we are very worried and have many questions/ concerns and hope you could offer some advice /views –
1. Any advice on proceeding to BMT with 9/10 match?
2. Is allele mismatch at DRB1 a significant mismatch? What are the expected/potential impact on transplant outcome with this mismatch? Any research or studies on this?
3. With heavy transfusion ( about 300 bags of RBC and platelets in total in the past few years)), will it has adverse impact on the transplant success and outcome?
4. Doctor said my niece will receive chemotherapy and radiotherapy prior to transplant, but no details provided yet. For severe aplastic anemia, is the intensity of conditioning regimen the same as that for leukemia ? Or it would be lighter?
Would appreciate your advice and sharing of your clinical experience Thanks much in advance.
21 July 2019
Dear Dr XXXXXXX
I have sought your advice four years ago regarding my niece’s aplastic anemia, and thanks much for your avice in the thread
https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=210833
My niece has increased eltrombopag to 125 mg in 2015 but no notable improvement. She received 2nd ATG (rabbit) in late 2017 but no response. Her conditions keep declining and is now receiving platelet transfusion once every week, RBC transfusion about once every two or three weeks, also has neupogen injection once every week. Has received over 150 bags RBC and over 150 bags platelets since she has transfusion need.
She will need to do bone marrow transplant. She has no sibling match, and found a 10/10 match but unfortunately the potential donor refused to donate. Her best match found now is 9/10, with one allele mismatch at DRB1. Doctor said it is not perfect match but could still proceed to transplant, but she could not tell the chance of success for a 9/10 match as compared to 10/10 match. Given my niece’s serious conditions now and that we have already initiated donor search since October last year, we reckon that the chance of finding another 10/10 match is slim. We therefore have decided to proceed to BMT. Yet we are very worried and have many questions/ concerns and hope you could offer some advice /views –
1. Any advice on proceeding to BMT with 9/10 match?
2. Is allele mismatch at DRB1 a significant mismatch? What are the expected/potential impact on transplant outcome with this mismatch? Any research or studies on this?
3. With heavy transfusion ( about 300 bags of RBC and platelets in total in the past few years)), will it has adverse impact on the transplant success and outcome?
4. Doctor said my niece will receive chemotherapy and radiotherapy prior to transplant, but no details provided yet. For severe aplastic anemia, is the intensity of conditioning regimen the same as that for leukemia ? Or it would be lighter?
Would appreciate your advice and sharing of your clinical experience Thanks much in advance.
Brief Answer:
I think transplant will be needed
Detailed Answer:
Hi
Thanks for following up.
Considering that no other better option is available right now, I feel transplant with 9/10 match is doable. Results are definitely not as good as 10/10 but still acceptable.
DRB1 mismatch is significant but in many cases transplant may succeed.
Lot of transfusions definitely have negative impact on transplant outcome but on the other hand, no better option is available.
The induction regimen varies so I can't comment on the exact regimen choses by her doctor. Usually it is a little lighter than leukemia, but only just.
Hope this helps. Wish the best for your niece.
Regards
I think transplant will be needed
Detailed Answer:
Hi
Thanks for following up.
Considering that no other better option is available right now, I feel transplant with 9/10 match is doable. Results are definitely not as good as 10/10 but still acceptable.
DRB1 mismatch is significant but in many cases transplant may succeed.
Lot of transfusions definitely have negative impact on transplant outcome but on the other hand, no better option is available.
The induction regimen varies so I can't comment on the exact regimen choses by her doctor. Usually it is a little lighter than leukemia, but only just.
Hope this helps. Wish the best for your niece.
Regards
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Dr. Prasad
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