[Lisa V]

Mark, how old are you? How close a match is your sister? What type of MDS do you have and what is the prognosis without a transplant? If your doctor feels it's better to wait, have you asked him/her why?

There is no one-size-fits-all answer as to whether or not to go to transplant, or how quickly to go. It all depends on your circumstances and what other options are available. Generally younger patients are pushed in that direction more often, but as you age the risks go up, particularly once you pass 40. Nowadays doctors will sometimes transplant for patients into their 60s, and maybe even higher if they have a very good match and their overall health is otherwise good, but that must be evaluated by an experienced transplant doctor.

If it seems as though a transplant is inevitable then your sister is right, the sooner the better. The more transfusions you have and the longer you wait, the more possibility there is of complications arising. On the other hand, if there's a chance for a normal life without one, or if you have a less than perfect match, or if the risks because of your age or condition seem high, then it makes sense to avoid it as long as possible. Your freight train analogy seems right on target to me, this will have a huge impact on every aspect of your life!

Also, is there a reason you prefer to be treated in your own hospital rather than your sister's? The more experience your transplant team has the better. It is a complicated business and many people travel halfway around the world to go to where they have the best track record. If you have a Center of Excellence in Toronto, then I'd go there first.