Hi Nancy,
There are two acceptable approaches when starting to taper:
1. At least 6 mo after ATG, AND after platelets went over 100 or
2. After 6 to 12 mo after ATG, AND platelets stayed the same for like 3 - 4 mo, even if below 100.
Fro your description, you're good to go :-)
My hematologist wants to begin a very slow reduction in cyclosporin by 25 mg per day (I'm currently taking 125 mg in a.m. and 125 mg in p.m.). She explains my blood levels may always be just a bit below normal.
I think she meant 25 mg/mo, so the whole taper will be 10 mo. I think this is a very good idea. There is clear evidence that slow taper is the KEY for a solid remission with slim chances of relapse. The following article mentions a study that has done specifically on tapering CsA, although on a pediatric population:
http://asheducationbook.hematologyli...urcetype=HWCIT
This is the relevant part for you. My comments are in [square parenthesis].
"Current IST regimens including CsA call for a full CsA dose (5 mg/kg orally per day) for 6 months; after this time point, CsA is tapered, and it is unclear exactly (1) when and (2) how fast this should be done. In recent study, 42 children were divided into three groups: very slow tapering (<0.3 mg/kg/month) [16 mo], slow CsA tapering (0.4–0.7 mg/kg/month)[7 -12 mo] and rapid tapering (≥0.8 mg/kg/month)[less than 7 mo]. The cumulative incidence of relapse was 8% in the slow/very slow taper group and 60% in the rapid taper group.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."
Your doctor is thinking about 10% per mo, which is in line with the research. However, if you are taking Neoral (liquid), it might be easier to go down 20 mg per month, due to the syringe gradations. This will bring the time to about 12 mo, quite acceptable. If you take pills, then 25 mg/mo is the dose.
Sandra