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I am A 73 YO male. I went from no problem to MDS RAEB-2 in less than 6 months. I don't know how long because that was the test intervals. I could have happened overnight, but who knows. For the past 3 months my CBC has been pretty stable with HGB 10.2, HCT 33.8, WBC 1.3, ANC .3. My platelets went from 100 to 40 after starting the AG221. AG221 has not changed any of the CBC numbers other than platelets. Blasts have gone from 13% to 4%. I am weighing my options.
Let nature take its course. 50% mortality in 8 months, small chance of living past 2 years.
Vidaza. 19% chance of working. Can cause remission of several months to a few years. Remission length probably short for very high risk cases such as mine. I look at it as a stepping stone for a transplant. AG221 offers better odds.
AG221 looks very promising. It is likely on the leading edge of novel MDS treatments to come. Caused dramatic reduction of blast counts, not much on CBC. It has a scant track record of 6 months. Do I looks at this as a cure or a stepping stone to transplant? In light of my sudden onset of MDS I am concerned about a similar rapid relapse. If I thought AG221 would give me a couple years of quality life I would do it in a heart beat. I am not ready to roll those dice. At present I get BMB every 2 weeks, blood work every week. Starting next month BMB goes to every other month, and blood work every 2 weeks. I would have cut AG221 more slack if I had seen improved CBC.
Transplant offers a 30% chance of a cure, 30% chance of dying in the first year, with the rest of the odds taken by relapse, GVSH disease and other unpleasant niceties.
I am caught between a rock and a hard place. My current thinking is too take the AG221 until I see no more improvement and then do the transplant. I have two healthy sisters who are 10/10 matches.
I would appreciate anyone point out flaws in my logic.
Ray
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