trialad2,
What were your husband's counts before and after his first round of ATG? What was his dosage on cyclosporine? How long was he on prednisone?
Although 48 is young for MDS transplants, it is considered riskier for AA transplants, which is probably why his doctors are pushing the IST again first. There is a great paper entitled "Making Therapeutic Decisions in Adults with AA" that gives a good flow chart of the current preferred treatments:
http://asheducationbook.hematologyli...full/2006/1/78
Many people relapse after their first round of ATG. It is not uncommon to have the second round stick - especially if he had a response the first time.
I wonder if there is an alternative serum sickness drug to prednisone to minimize the risk of further AVN? I know the side effects of prednisone last a while after a person stops taking the drug, and it sounds like your husband had the worst of them
Also, you may want to discuss the option of using ALG instead of ATG, as it has reportedly fewer side effects.
There is a very active AA forum that you may want to check out for more advice:
http://aplasticcentral.com/test/toas...n=topics&fid=2
Keep believing!