I’m 71, a physician, and 12 months out from a diagnosis of HR-MDS. I’ve had a nice response to azacytidine, with Hgb running around 11.5; platelets 80-100K; and ANC 600-800. Plan is to add venetoclax when my counts start dropping. My goal is “good life” — be as vital as possible, even if it means a somewhat shorter lifespan. I had a consultation at a well-recognized bone-marrow-transplant center, and to my surprise, the transplant specialist recommended my current treatment plan, and not pursue transplant. He said a BMT would involve at least a year of poor functional status, with a high likelihood of recurrent hospitalizations, with a five-year survival of about 30%. Neither of us perceived such a trajectory to fit my values and goals of care. (There are numerous studies that show that physicians, when they are patients themselves, choose less aggressive care, as I am doing.)
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