Survivor with a potentially interesting question....

[Tripper11]

I have a 5yr survivor of Acute Myloid Leukemia. I had a pretty easy run as far as beating this disease. Not overly sick compared to others I met in the hospital.
I was dx'ed in June of 2002 and went into remission in mid July. November 27th after a lot of thought, consultation etc I chose to have a stem cell transplant.
My donor was my brother, my only sibling. We were a perfect match and I came through the transplant with flying colours!!!

Now comes the interesting part.

My brother, was recently diagnosed with the exact same disease. His struggle has been a lot tougher then mine by far. He's lost a ton of weight, can hardly eat, and is always very weak.
He's has a lot of support with his family and our parents though.
He is currently in remission as well, but is also receiving a secondary treatment, to a lump behind his pituitary gland. He had an Ommaya reservoir installed and receives one chemo dose every Friday. It's unclear if the lump is malignant, but this is more of a better to be safe then sorry.

Now it seems they are talking transplant. I asked my Mother if they know who the donor might be....it's ME! At least that's the beginning of the discussion.

So my question here is...does anyone know of, or heard of a recipient giving back to his donor? I've only begun my research and have yet to find anything. I have also sent an email to my team here asking if they have any info or know of any other situations like this.

Thanks for reading and any help that might come my way!

[seemunkee]

1. Search Medline and see what you can find

http://www.nlm.nih.gov/medlineplus/
Never heard of it before and I asked my wife (she had worked on cancer clinical trials for decades) and she hadn't heard of it either.
Hope things work out for your brother and you continue to have good health.

[Tripper11]

2. Thanks seemunkee.....

As I mentioned in my original post, I have consulted my original team that treated me. We are in the final apppointments as I come up on my 5yrs anniversary.

My oncologist is looking into it and hopefully I may know more in a week or so.

[Tripper11]

3. Got a reply from my doc....

Here is his reply. Interesting IMHO.

Although I don't know all the details about Mr. XXXX's AML nor his brother's recent leukemia* -- my initial thoughts are that Mr. XXXX would not be a desired stem cell donor but could be considered if no other
suitable donor was available.
*to be fair to the good doctor, he was just given my case as my original oncologist has moved on.


The concerns about using Mr. XXXX for his brother include:
(1) Although we think Mr. XXXX is cured of his AML from 5 yrs ago - there is a small chance of late relapse and therefore transmitting Mr. XXXX's AML disease to the brother
(2) It's possible that Mr. XXXX received some of the brother's leukemic (or preleukemic) cells along with the brother's healthy stem cells - and
and that they are currently "resting" or not active in Mr. XXXX's body - but they might be transmitted back to the brother with harvested stem cells
(3) One advantage to performing allogeneic transplant, instead of autologous transplant, is that the donor's immune system can exert a graft-versus-leukemia effect against the recipient's malignant disease (this results in lower relapse rates for allo transplants compared to autologous transplants). Giving stem cells from Mr. XXXX back to his brother would essentially be equivalent to doing an autologous stem cell transplant - but using cells that had been passed through Mr. XXXX's body. After the transplant, the brother's immune system would reconstitute with his own immune system (that had been transmitted back from Mr. XXXX). In that setting, there would not be an allogeneic graft-versus-leukemia effect.

The potential benefits of Mr. XXXX serving as his brother's donor are:
(1) As alluded to above - it would be like an autologous transplant and, therefore, there should not be the risk of graft-versus-host disease.
(2) If Mr. XXXX's brother's stem cells from 5 years ago did not contain any of the brother's preleukemic (or leukemic) cells - and if Mr. XXXX's old AML is gone for good - the stem cells coming from Mr. XXXX and going
back to the brother would be a "cleaner" source of autologous stem cells at this point than harvesting the brother's stem cells in 1st CR and using those for an autologous transplant (with the risk that they could
contain residual leukemic cells - that are undetectable - and/or that the brother's healthy stem cells have been exposed to a lot of chemotherapy and they might carry a predisposition to another preleukemia/leukemia).

The relative benefits and risks of using Mr. XXXX's stem cells must be carefully considered and weighed - based on the brother's leukemia risk factors and chances of cure with chemotherapy alone, autologous transplant and allogeneic transplant (from a related or unrelated donor); the chances of survival with an autologous transplant (which might be improved by using "clean" autologous stem cells from Mr. XXXX); and the potential options and benefits of using alternative allogeneic donors. In regards to other related donors - I'd be concerned that 2
siblings in this family have developed AML and that other siblings might be at increased risk of AML.

[seemunkee]

4. Thanks for the update

Any other possible family donors?

[Tripper11]

6. Nope...just him and I in the immediate family.

They wouyld have to branch out their search.

[MsRedacted]

5. Interesting -- I have a friend going through a similar situation. He needs

a stransplant -- his Dad died of AML -- his brother is a mach, and they are testing his brother to make sure there is no sign of AML.