Dr Furman re elimination of CLL stem cells

[Guest guest]

Dr Furman,

I was reading a recent article by Kolb in Blood on how HSCT produce

durable remissions and I came across two alternative hypothesis. There

were either it is accomplished by the elimination of the leukemic stem

cells or by the persistent immune control of their progeny. Seeing as

I am 140 days post RIC MUD HSCT with no evidence of disease, but

likely rejecting my graft, I am rooting for the first. Does CLL have

stem cells that might be eliminated in the first few months post

transplant? I don't want to make future treatment decisions based on

wishful thinking or faulty understanding.

Thank you

, 57 yr family doc & father of 4, dx 9/05 del 11q unmutated, ZAP

70+ CD38+, ITP 9/06 eventually failed steroids, IVIG , Rituxan and

splenectomy controlled w cyclosporin A & Rituxan combo. CLL in old

school CR. RIC MUD HSCT July 1/08 now CR with no nodes > 8mm and PB &

BMB MRD - probably rejecting graft after 4 months see

http://bkoffman.blogspot.com/

[Guest guest]

,

I am sorry to hear about your graft rejection. We really do not know

the answer. The other problem is that it does require sometime for

the graft to develop an immune response against the CLL. Hopefully

it was sufficient for your needs.

Rick Furman, MD.

>

> Dr Furman,

> I was reading a recent article by Kolb in Blood on how HSCT

produce

> durable remissions and I came across two alternative hypothesis.

There

> were either it is accomplished by the elimination of the leukemic

stem

> cells or by the persistent immune control of their progeny. Seeing

as

> I am 140 days post RIC MUD HSCT with no evidence of disease, but

> likely rejecting my graft, I am rooting for the first. Does CLL

have

> stem cells that might be eliminated in the first few months post

> transplant? I don't want to make future treatment decisions based

on

> wishful thinking or faulty understanding.

> Thank you

> , 57 yr family doc & father of 4, dx 9/05 del 11q unmutated,

ZAP

> 70+ CD38+, ITP 9/06 eventually failed steroids, IVIG , Rituxan and

> splenectomy controlled w cyclosporin A & Rituxan combo. CLL in

old

> school CR. RIC MUD HSCT July 1/08 now CR with no nodes > 8mm and

PB &

> BMB MRD - probably rejecting graft after 4 months see

http://bkoffman.blogspot.com/

>