[DanL]

I am sorry to hear about your husband's relapse. It looks like your physicians are considering something that looks like a lower intensity conditioning regimen with a DLI. Basically this would work on depleting some of the MDS cancer cells, and give the existing graft a bit of a booster shot, while minimizing the damage from transplant.

the antibody that would be going with the fludarabine is usually ATG (anti-thymocyte globuulin). The syrum comes from either a horse or a rabbit. It is a powerful immune suppressant that helps reduce graft rejection. ATG can be a rough ride for the couple of days that you take it, but it is mostly flu-like symptoms - fever, chills, body aches. I had 3 days of ATG prior to my transplant and really the first day was the hard one.

As for timing - if the doctor is saying sooner than later, he believes that the risk of waiting is worse than the risk of administering the chemo and DLI. there is a "magic number" of about 12-14% blasts that you want to be below prior to transplant, so if they feel like the disease is progressing or is likely to progress quickly, this may be the big driver. Very rarely do blasts decrease on their own.

It has been a hard lesson for me because I am analytical and want all of the answers before going in, but the key is that if you like the team of doctors that you have, ask the questions, but trust the doctor's guidance on timing.

Best of luck for you husband and you.