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Hi Fana,
My understanding is that while relapse is a possibility after both ATG and BMT, the chances of relapse is much higher with ATG. I believe about 70% of patients have a good response to ATG, but of those, about 30% eventually relapse and about 10% have clonal evolution to PNH, MDS or AML. Also with BMT, clonal evolution is a possibility, but a much smaller probability than with ATG (not sure of the exact percent).
The clonal evolution is usually found via a bone marrow biopsy, where they look at the chromosomes and other features of the cells in your marrow to see if there are any indicators of these other diseases. I believe hematologists are not certain whether this clonal evolution is due to the ATG/cyclosporine treatment itself, or is part of the natural progression of aplastic anemia in certain patients. But either way, since a successful BMT should fully replace your diseased cells with new healthy ones, the probability of any clonal evolution in that case is much lower.
With both ATG and BMT, the longer a patient remains healthy with good counts after a successful response to treatment, the less of a probability there will be a relapse or evolution to another blood disease.
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Kevin, male age 45; dx SAA 02/2012 - Hgb 5.8, platelets 14, ANC 200, 1% cellularity. Received ATG 03/2012. As of 03/2015, significant improvement - Hgb 15, platelets 158, ANC fluctuates around 1000, Lymphocytes 620. Tapering cyclosporine. BMB 20-30% cellularity.
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