Graphic depiction of the fall in donor chimerism at relapse of JMML after transplantation and the response to DLI with prompt and sustained return to donor chimerism.

This patient initially had recurrence of host hemopoiesis at day 68 after transplantation. By day +102 this had progressed to 83% host MNCs and 10% host PMNs. DLI was given on day 114. GVHD that followed the DLI was treated with steroids for 1 week from day +138 to day +145. By day 35 following the DLI (day 148 after transplantation), there was return to 100% donor chimerism, and the patient remains well and disease free 17 months after transplantation. BMT indicates bone marrow transplantation.