Why drug treatment instead of BM transplant?

[Cheryl C]

Hi everyone - I'm just interested in knowing if any of you have had the option of a bone marrow transplant but have chosen drug regimes instead?

I am 64, MDS RAEB 10% blasts at my last BMB 5 mths ago, and have just learned that my brother is compatible. I need to make the choice between drug treatment and a transplant. In Australia where I live drug treatment is only available via drug trials (no placebos) which go for 2 years.

I'm having trouble knowing which is the best choice and would appreciate hearing from others who have been in this situation.

Thanks!

[Neil Cuadra]

It's a very tough choice to make, Cheryl, and I don't envy you having to decide.

One important factor is your IPSS classification (low-risk, intermediate-1, intermediate-2, or high-risk. Have you been classified on that scale?

Another is what they call comorbidities (a rather icky word, if you ask me). It means other major health conditions (diabetes, high blood pressure, pulmonary or kidney problems, etc.) that put you in a higher risk category than the healthiest patients of your age group, even if you ignore the MDS.

The higher your IPSS risk and the fewer your comorbidities, the more likely it is that doctors will recommend a transplant over drug therapy.

[Greg H]

Hey Cheryl!

Neil makes great points. Another consideration, particularly at age 64, is the kind of conditioning regimen. A traditional myeloablative transplant is going to be harder on you than a reduced intensity transplant and will pose a greater risk. A reduced intensity transplant will have a greater chance of relapse.

It's great you have a sibling donor. Even though the numbers get closer and closer over time, a sibling transplant still seems to have a small advantage over a match unrelated donor.

It's tough to be in a position of having to choose one or the other.

Good luck!

Greg

[Cheryl C]

Thank you Neil and Greg for taking the time to encourage and advise.

Just reporting the good news that after my bone marrow biopsy on 30/1/12 my results have shown a drop in blast cells from September 2011's 10% to 2%! This is amazing because I haven't had any treatment yet. Was gearing up with my specialist for a transplant as I have no other comorbidities and he was expecting that the blasts would continue increasing.

The bad news of course is that I still have MDS, but am no longer in the RAEB category - have moved into refractory cytopenia multilineage dysplasia, which is lower risk. How blessed I am - I am very thankful. I feel as though I have been let out of jail for the present!

Has anyone else experienced this unusual drop in blasts? If so did it last?

My white cell count hasn't improved at all, neither have my platelets. Red blood cells still holding at almost normal levels.