Is Cyclosporin counter-intuitive

Mel

how does this, an immuno-suppressant and high dose steroids [also immuno-suppressant] for GvHD equate with the need for neutrophils the essential ingredient for immunity? Is it a highly refined balancing ? My husband is Day 18 and quite poorly at the mo.

Hayley_Anthony Nolan

Hi Mel,

Thanks for this post of a very logical question. You are right that it is a balancing act between allowing the new stem cells to grow and so increasing white blood and neutrophil counts etc. to reducing the risk of severe GvHD. It might not seem logical to start Cyclosporin at the beginning of a transplant but we can suppress the immune system enough to prevent severe GvHD but not so much that it stops the new donor stem cells to regenerate and grow. There is also regular monitoring of cyclosporin levels to ensure the correct therapeutic doses. In most cases this works well, and it is when the blood counts are at a good, stable level that the immunosupression can then begin to be reduced. This will increase the risk of GvHD but it is a safer time as the immune system is a bit stronger. If while reducing the immunosupression GvHD occurs and the immunosupression needs to be increased or steriods used the immune system is not so fragile and is able to cope with the higher doses of immunosupression. The white counts will still fluctuate but the team will keep a close eye on them. Two things to remember are, that the point at which the immunosupression begins to be reduced will vary between each patient depending on their blood count and overall recovery and we can give the immune system a boost with a drug called GCSF if needed.

Although it is unlikely that patients will experience GvHD in the first few weeks after transplant, it can happen, and in that case treatment will be with increased immunosupression because controlling GvHD would be the priority. Any drop in white count would then be controlled with GCSF.

It can be a challenging time and it can also mean juggling medications to find the balance but the transplant team will be very experienced at doing this. I would always recommend discussing any questions you have about your husbands specific treatment with his team. You are also welcome to call us on 0303 303 0303 if you have any questions or want to talk anything through.

Best wisehs
Hayley

Mel

Hi Hayley, I am just catching up on things [takes a while!] and see I never acknowledged your very helpful reply to my question which has been very supportive during the time since my husband's transplant. We both take a close interest in the blood results and drugs movements, and this helped us appreciate the reasons behind some of the otherwise apparently rather 'random' nature of how things have worked. Thank you.