[Hopeful]

Hi Tami,

I think you have good reason to be concerned. Your son's cyclosporine taper may have been too rapid or started too soon. Current thinking is that a very slow taper is most effective in preventing relapse.

Here is a section of an article from http://asheducationbook.hematologyli...full/2007/1/23
The article is titled "Aplastic Anemia: Pathogenesis and Treatment" by Andrea Bacigalupo

Cyclosporin dependence and relapse

Current IST regimens including CsA call for a full CsA dose (5 mg/kg orally per day) for 6 months; after thistime point, CsA is tapered, and it is unclear exactly (1) when and (2) how fast this should be done. A recent, as-yet-unpublished study of the Italian pediatric group has addressed these two questions. In this study, 42 children were divided into three groups: very slow tapering (<0.3 mg/kg/month), slow CsA tapering (0.4–0.7 mg/kg/month) and rapid tapering (0.8 mg/kg/month). The cumulative incidence of relapse was 8% in the slow/very slow taper group and 60% in the rapid taper group.19 Among patients who eventually discontinued CsA, the median duration of CsA treatment at full therapeutic dose (4–6 mg/kg) was 12 months (range 3–45 months), and tapering was completed in a median of 19 months (range: 4–64 months). In that study, the actuarial probability of discontinuing CsA was 21% at 5 years, 38% at 7 years, and 60% at 10 years, respectively.19 This study suggests that (1) it is safe to start taper CsA at 12 months of treatment (rather than 6 months) and (2) that taper should be very slow (less than 10% of the dose/month) for at least 1 year, to minimize the risk of relapse.

The good news is that increasing his Cyclosporine could stop the slide. Talk to your doctor soon (or a second opinion) about increasing his dosage.