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Hi chrplunk,
How long ago were the tooth extractions? Did she have excessive bleeding from the procedure? Did she have a recent cold/infection? All these can contribute to a drop in platelets, which may be just coincidental with starting CsA.
The benefits of cyclosporine are usually seen 2-3 months after initiating therapy.
I've never heard of a marked decrease in platelets from starting CsA alone.
It seems like a very reasonable approach to try CsA before moving on to the hypomethelating drugs, given her presentation. With immune therapy, there is the hope of a longer remission than can be achieved with the other drugs.
Hopefully, you'll see a reversal in the trend at her next CBC.
As a side note, my BMBs sometimes were hypocellular and sometimes were hypercellular.
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55 yo female, dx 9/08, AA/hypo-MDS, subclinical PNH, ATG/CsA 12/08, partial response. small trisomy 6 clone, low-dose cyclosporine dependent
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