BMT after relapse
 

Hi! Last year I diagnosed with severe Aplastic Anemia. I had ATG combine with Cyclosporine with excellent respone and normal blood count after only two weeks!!! two month ago I had a relapse due to the tapering of the cyclosporine. I have unrealated match donor and the doctor said we should go for BMT and not repeat the ATG course. I can't decide what to do, the immunosuppressive therapy went so good last time and I think I should repeat that therapy without tappering the Cyclosporine

what do you suggest??
thanks, Kobi

If it were me, and it was too late to turn things around with cyclosporine alone, I would repeat the ATG with cyclosporine but extend the cyclosporine to 6 - 12 months before beginning a very very slow taper. This is assuming your counts rebound quickly again.

I would only consider the BMT if this approach failed.

I think a lot depends on your age and how many matches you have. My son just had ATG so it is too early to tell if it is work. He is 8 and is lucky to have a lot of perfect matches on our bone marrow registry but I think that just makes them more anxious to do it. They're already talking about doing it if this doesn't work. Sort of like "oh, the matches are out there, it's a shame to waste them." I think I'd rather go for a second round of ATG and see if that works. Hopefully my son will recover nicely on this round of ATG and it will be a moot point. I do think Drs. sometimes talk about it like it's not a big deal but with 35-40% of recipients getting chronic graft-vs.-host disease (GVHD) I feel like it still is. Also, you get cyclosporine after the transplant to prevent GVHD so there is still a chance that you'd be on it long term anyway. It's a hard decision. Good luck!

I think I would get a second opinion, the BMT seems a bit early given that you had a good response to ATG the first time.

In any case, I wish you well!