[marmab]

I feel like I need some advice about trying a third round of ATG. I had no response to my first ATG, and a minimal response to my second ATG, a year ago. I have been transfusion free since 9/12, but my counts, after reaching their highest numbers in 11/12 (Plts 56, Hgb 9.4), have been declining since then, and I needed transfusions again last week. My doctor wants me to consider BMT; in fact, we started down that road 6/12 and preliminary matching was done at that time. However, I was (and am) reluctant to go that route, so he is offering me ATG again. Is this throwing good money after bad, so to speak? I am caught in the conundrum of being (relatively) young and quite healthy (other than having this disease), and thus having a good chance with BMT at this point, BUT, because I am young and healthy, able to function OK, so far, without going the BMT route, especially if I do get some kind of response from a third round of ATG. My doctor is planning another BMB soon to see what's going on in my marrow. If it is still very hypocellular, he feels that I need to stop ignoring the writing on the wall and go for a BMT, and better done now, while I am healthy. But he respects my reluctance, so he is ultimately leaving the decision to me. I guess that a determining factor may be whether or not I continue needing transfusions. Sorry to go on at length, here, but I'm hoping that others' experiences can help me in my decision making.