[gramous]

hallo Shriya,

I'm so sorry that your father is on the mds boat.

Ring sideroblast are not the same than blast.
Ring sideroblast are immature red blood cells with iron deposit... these blood cell are inefficient because the not good utilisation of iron but don't indicate a evolution of the desease to leukemia.
Blast are immature cells at the predifferenciation level (before the differenciation between red blood cells, white blood cells and platelets).
The blasts increasing (more than 5% in bone marrow aspiration) are a sign of desease progression and indicate that a more agressive treatment than supportative care must be initiated.... like vidazza.
RARS is a sub entity of mds which is usually in low risk category...I think that the probability of evolution to leukemia is the lowest of mds subtype... So I can't believe that evolution can happened so far, I think that the first bonemarrow biopsy was non representative..... Moreover, the fact that his platelets are low and the hemoglobine also makes me think that he was not RARS but eventually RMCD (dysplasia with sideroblast of more than one line cell, here platelets and red blood cell). In RARS type, the doctor test also the jak2 mutation.
Mark also that you can have simultanious ring sideroblast (caracteristic of RARS of RCMD) and blast.
The other point that I don't understand : why is the first choice treatment lenalidomide because this is usually used for the patient with 5q chromosomal delation... Vidazza is usually the first treatment choice for high risk mds... When vidazza doesn't work, you can use, I think, revlimid of dacogen (can anyone confirme this?).

Check the copper and zink level, here it is automaticcely check when you're sideroblastic type because a depletion in copper can cause the same symptoms.

I hope that can help and I'm sorry for my bad English.

Take care of your father, moral and support are important in this desease.

friendly regards,