[Neil Cuadra]

Terry,

I'm sorry for the loss to you and your family. Unlike a few decades ago, many patients in their 60s and even in their late 70s, with otherwise good health, are now good candidates for transplants. But the risk is still high, because average transplant-related mortality for MDS can be somewhere between 15% to 25%. Doctors still look at these types of numbers when recommending for or against a transplant for a particular patient's circumstances.

They compare the transplant risk with the lowest risk of treatment (wait and watch) and with the medium risks of drug treatments, which for MDS have an average overall response rate (meaning some improvement) of over 50%, but a complete remission rate of only about 15%.

If initial searches of the bone marrow registries had not produced an ideal match, that would certainly have argued for delaying a transplant as well. Doctors used to be much less inclined to proceed to transplant when a patient had no matched siblings, but the success rates of unrelated donor transplants, especially with donors on the young side, have become comparable.

It's unfortunate that physicians have to play the odds this way. It helps them save the maximum number of patients, but it's only natural to second-guess these decisions when a patient does not survive, as in this case. Because some MDS patients don't progress to AML, a high-risk treatment can be less than ideal, especially when you factor in quality of life.

The bottom line is that we can't know what would have happened under different circumstances. If your mother's physicians were experienced, and you and she had confidence in them, then I hope you'll conclude that they did the best they could for her, and not be haunted by "what ifs."