[DanL]

Greg,

Hard to say with the Revlimid option. Many people experience short-term reductions in platelets/RBC only to see them increase and get back into the normal range after a couple of months. I did see a recent study that tied transfusion independence to initial starting dose, which is 10mg/day as opposed to the 5mg dosage, although many people do respond to the lower dose. A lot of folks go through at least a temporary dose reduction, but this does not seem to alter the overall response.

Although i normally swim upstream, i think that I am falling in-line with the crowd here and saying that Revlimid seems like a logical choice. The very bright spot is that most responses are within 90 days, so you would not be wasting a lot of time on the drug.

For some reason though, I would want to know more about why Thalidomide is off the table. It tends to do well with mild fibrosis and helps increase RBC in a good number of patients when the dosage is not very high, as Birgitta mentioned earlier. 100-200mg/day seems to be the sweet spot.

I am pretty sure the answers are yes, but have you already been tested for the Jak2 V617f mutation and for PDGFRB? For the latter, Gleevec has been used successfully - for the former, I haven't seen a whole lot of research, but a Jak inhibitor might be interesting.

this may have been 4c worth of feedback though.

Good luck finding the answer!