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marmab,
Which MDS forum did you join? Others may find it useful too.
Have you needed any blood or platelet transfusions?
Watch-and-wait is a reasonable initial strategy but if your counts continue to drop you may need treatment. And that requires a correct diagnosis, so you're asking the right question about hypoplastic MDS vs. aplastic anemia. Ask your hematologist why he/she thinks it's MDS so you can compare with the opinion you get at Dana Farber.
To me it seems premature to be talking about a transplant without first confirming the diagnosis, getting a subtype classification and scoring if it's MDS, and weighing the tradeoffs of drug treatments as well. You are lucky to be otherwise healthy so you have all of these options. And maybe your counts will recover and you won't need treatment at all.
"Hopeful" mentioned immunosupressive therapy (IST). That's common for aplastic anemia, and IST can be effective for hypocellular MDS as well (more so than for MDS with normal cellularity). That's why it may be a possibility for you. If you do indeed have MDS, there are chemo drugs, but they are more often given for higher risk MDS than for lower risk MDS. Transplants can cure either disease but involve their own risks. Treatment decisions are very individual so the more information you and your doctors have, the better.
The cell percentage is called cellularity and you are correct that you are hypocellular. 10% is lower than the 40-50% that's normal for your age and they generally call it hypocellular when it's under 20% to 30% for your age.
BOOP and MDS are both rare and the combination is even rarer. They also have something else in common: most cases have unknown causes. That means that their causes could be related. MDS is considered a possible cause of BOOP, and so are radiation and drugs like cyclophosphamide that are used as treatments for MDS.
We're patients and caregivers so we don't understand everything to the degree that the doctors do, but when we keep asking questions and sharing what we know it gives us the best chance to help each other.
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