[evansmom]

I agree that if there is an unrelated or cord blood unit match, transplant is the only way to go at this point. Studies do show that there are several know factors that lend themselves to a poorer outcome post transplantation: increased length of time on and amount used of immunosuppression previously (ATG, cyclosporin, prednisone, etc.), the length of time from diagnosis and the number of transfusions one has received.

I am a big believer in not repeating a treatment that didn't give the desired results (full remission) the first time around. It was easier (somewhat) for us because my son was a complete non-responder six months out from his one and only ATG treatment. His hematology team left the decision between 2nd round ATG and BMT with us. Evan had one unrelated 9/10 donor and two 5/6 cord blood units available to him. We had already done the research so we knew BMT was the right choice. We then had to decide on where the cells would come from, as no source was a perfect match. We went with the living donor because the mismatch was less serious than with the cords plus we could approach him again if we needed to. Evan's BMT was a total success without complication and I should mention that I know of another AA child who, like your son, had two rounds of ATG with only short-term partial responses and had to go over a year on transfusions and isolation because she had no donor. When her mom became desperate and started asking about other options like cord blood, a 4/6 match was located. Not the greatest match but it was there only chance. Aurora, who is 13 now and around 18 months post transplant had a completely uncomplicated transplant and is in perfect health today. No GVH or other issues, except some lingering iron overload.

All that to say exhaust every transplant option there may be before going to ATG again. Your son has young age, few transfusions and healthy organs on his side.

Hope this helps,