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@ mola-tecta:
Interesting...I don't know but I think that my mother has natural rises in hemoglobin after transfusions. Who knows? Maybe getting blood does stimulate the bone marrow somehow. Again, who knows?
1.4 is still really good, for an ANC. My mother's ANC averages around 1.1-1.2. Her hematologist says that this is good enough for overall protection, although not ideal. But ideal doesn't always mean great protection, because people with higher neutrophils can get sicker than those with lower neutrophils. My mother's doctor said that she wants them over 0.8. She got concerned when they dropped under 0.5 last spring and summer.
For older people with aplastic anemia, it can take well over a year before the person gets off transfusions. As long as one line gets better (3 lines: neutrophils, platelets and red blood cells) by 9 months or more, the other lines should follow suit from what I read at some point in the coming months. Did I tell you that a 72 year-old with aplastic anemia took two years to get off weekly blood/platelets transfusions before the horse ATG kicked in? That is an extreme case, but it tells you that ATG can still end up working, ever after 2 years. She refused the rabbit and waited it out. On her 25 month post ATG, she had a real rlse in blood and has never been transfused since (5 years on). She said it took another year for her hemoglobin to stay at normal levels. Wow!
We're going to wait at least 13-14 months after ATG before doing the rabbit. If there is no improvement in blood and platelets by late spring, we will have to consider doing it, despite the higher neutrophil counts. My mother started out with 5% bone marrow cellularity at 69 years-old. I think waiting it out is the best route. If there had not been any improvement in neutrophils, I would be considering the rabbit more and more. But, you don't want the rabbit unless you know for sure that horse-ATG will not get you off blood transfusions. The rabbit serum is stronger and can cause more bone marrow changes (increasing PNH clone sizes, etc.). While I would not say it's a last resort like a bone marrow transplant, it needs to be weighed very seriously.
My mother's hematologist said that my mother had a high chance of success with rabbit-ALG, if horse were to fail (90% that either horse or rabbit would work). But, she has admitted that the ATG is working in regards to her neutrophils.
Yes, do expect your mother's ANC to drop a bit after stopping prednisone. 1.4 is still really good. As I said, my mother's hematologist said anything over 0.8 is fine, preferably 1.0 or more.
Health and happiness.
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