[KMac]

Hi Fana,

I am sorry to hear you have to go through this, but welcome to the forum. You have found a wonderful resource.

This is a hard decision for you. I believe either option, ATG or BMT, holds great possibility for an excellent outcome. However, both of course also have very serious risks. I believe BMT is the riskiest on the short term (rejection/GvHD), with the risk of ATG being longer term - relapse or clonal evolution to MDS/AML or PNH (though that can also happen after BMT, but less frequently).

As for myself, I am a 44 year old male, and the first thing my hospital (CBCI/PSL in Denver) did was check if my two siblings were a match. Neither was a good match, but if one of them was, I would have went ahead with the transplant then and there, even at my age. This is because hemtologists are getting so much better at BMT, and I understand the younger you are, the better chances of a good BMT outcome (but I think the same can be said of ATG). And BMT can be a true and complete cure, forever. I have a friend whose grandson received BMT from his sibling's cord blood over 20 years ago, at about your son's age, and he is doing great now, completely normal.

I am doing quite well 2+ years after ATG, but I recovered very slowly, and my counts still are not completely normal (I'm still neutropenic, but my platelets and hemoglobin are low-normal), and I still work through some fatigue. That is the hard thing about ATG, though it is less risky on the short-term, it is not a complete cure - few people achieve completely normal counts after it. But many do go on to feel completely normal post-ATG, and stay that way for decades or perhaps forever. So it can be an excellent treatment.

Not an easy choice for you. I wish you and your family the best as you make your decision. As hard as the choice is between ATG and BMT, I find solace and good fortune in considering how we have at least two good options to choose from, whereas in previous decades those with SAA had few if any treatment options.