[PaulS]

Hi - As far as transfusions go you mainly want to consider how you feel and how low your blood counts are - If you're hemoglobin is lower than 8 you probably feel pretty bad and a transfusion may make you feel better - depends on how well the Aranesp is working. Look at your WBC, Platelets and hemoglobin - and look at the trend - are one or more lines going down or are they stable? If you get a transfusion you'll want to see how it works - how long it lasts. Once or moth or so is a different situation than every week.

You may also want to discuss a broader treatment plan - for that you should know what your bone marrow looks like - what is the percentage of blasts? Are there cytogenetic abnormalities - and if so - what is the significance - do they put you at a higher risk, or do they suggest a drug such as Revlimid might be appropriate. When was your last BMB - and when will you have another - if you haven't had one for a while and your counts are trending down a BMB would be important.

If your counts are trending down,you might also ask if the DR. is considering a drug such as Vidaza? Why? Why not?

Last - ask why did the doctor think you wouldn't survive a transplant? What about a non-myloablative transplant? Does he know anyone whom he'd recommend for a consult? In my experience the best doctors freely consult with their peers, especially in difficult cases. They also are helpful in making referrals for transplant consult or second opinions.

Is your doctor a hematologist/oncologist?

If you have someone to go with you you may want to bring him/her - it can sometimes be difficult to process information. Also, don't hesitate to ask follow up questions if your doctor uses jargon or language you don't understand - don't be shy or afraid to ask him to explain. Sounds like you have a good relationship - so you should make sure you understand what he's talking about. Why? Is always a good question - as is "what does that mean?"

Good luck
Paul