[joesmith]

I am writing as I need advice from you for my mom who has just started Vidaza and completed the first cycle. My mom who is aged 60 years was diagnosed with secondary MDS in Sep 2013 (She is a Stage IV Breast Cancer Survivor). Her blasts have been between 7% to 15% (One doctor indicated 7% and the other 15%). She has no chromosomal abnormalities. She is not a candidate for transplant given the secondary MDS. Since Sep until 2 weeks ago she has been on painful growth factor injections and transfusions for RBC's. No platelet transfusions. She just started Vidaza two weeks back and completed the 7-inj course on Monday last week. She is expereincing serious drop in blood counts particualrly with platelets. Her Platelets were 14K before she started vidaza. Day 3 of Vidaza she had to take her first platelet transfusion as her platelet count had fallen to 5000. 3 days after her 7th dose of Vidaza her platelets dropped again to 5000 and she was given a second transfusion that caused an infection leading to fever and hosipitalization. She was given another dose of platelets at the hospital but her body outright rejected it. She has also had 3 RBC transfusions without any side effect since the start of Vidaza. After the 7th dose of Vidaza, starting on day 10 all three blodd counts have dropped drastically. My mom is on Day 15 now and her counst are WBC 1400, RBC fell to 7 but after multiple transfusion is around 10, platelets are only 4000 to 5000 (which the doctors consider as ZERO medically). My mom is in day

A few questions:

(a) Is this sharp drop of blood counts normal?

(b) On what days after the last dose of vidaza is the drop of blood counts the most?

(c) typically on what day forward do the blood counts start increasing?

(d) we are most concerned with her platelets. From your experience when can we expect to start seeing an increase in platelet counts?

Can you give any additional advice on what we can do to improve her counts, overall health and prepare for the second round of Vidazaz?

Does this drop in blood counts continue each month (every 4th week) or is this only in the first cycle? Any other advice?

Appreciate your guidance in this dark hour.