It is a dilemma for the Oncs. But I look at it like this. If the BMT chemo is stronger than the chemo used to reduce the blast count, then why do the interim chemo? It will just delay and weaken him before starting the BMT, and does nothing toward the cure. Chemo is not a freebie to the body -- each dosage takes its toll. And the stats do not apply very well across the board. The "no blasts before BMT" stats are fuzzy at best, and even then must be put into perspective. The key is that BJ is young, and he is healthy now. Why weaken him just to turn around and do the BMT chemo and radiation? Why delay the BMT just to hide the symptoms and also induce something the BMT chemo would do anyway? Do the Oncs have answers for this?
There are also other competing stats. "The optimal time of transplantation is controversial but thought to be up to 24 months following diagnosis."
http://www.patient.c...aemia-(CML).htm
It would be difficult to find data that clearly shows the effects of blast count on BMTs in CML patients. The following article discusses blast count and BMT survival in high risk AML and ALL patients, but these have lower probabilities of success than CML patients:
http://www.nature.co...l/1705594a.html
The stats are all over the map with regard to BMT. Age, donor matching, disease type, and stage play a huge role. The other stuff may just be noise level. If a person enters blast phase, the blasts can be reduced, but the person is technically still in blast phase, although the symptoms may be suppressed for a short time.
I do not know the right answer. There is no clear answer. There is never enough information. And the stats can get in the way of sound decision making when they are not properly applied.
