[tytd]

Hi Dan,
You seem to have a lot of factors in your favor including your young age, good performance status, lack of anemia and no need for transfusion. These might appear to outweigh the negative factors of fibrosis and low platelet as long as you are not having significant bleeding. You still must be in the IPSS intermediate risk category which might mean you should not jump to transplant too soon. On the other hand, I realize that the low platelets are a poor prognostic factor and it is hard to live with the restrictions they entail -- but I wondered what the pace or trend in your platelet drop has been and how well the platelets you have function??
I too get scared when they hit 19 or 20k, (something about that number seems worse than 21k.) My own experience, which I realize is unique, has been one of a very slow platelet decline. I have fluctuated between 16k to 22k over the past 2 years. I know that it is such a difficult decision about when to start treatment or go to transplant and I would seek several different expert opinions as I bet you have already done. Have you thought about a Promacta trial or Vidaza + Promacta trial? Good Luck tytd