I would worried about this child because of the poor early response, and his young age-we want to go for a cure in this case. That being said, he has responded pretty well (though I would hope for a lot more). I would guess that in his remaining years he will progress, but who knows when-Next year? Next 30 years? Given transplantations side effects on growth and sterility, I would try to keep him on DAS, and watch him like a hawk. We have a real advantage in that a donor is waiting in the wings, and presumably be mobilized quickly. If his PCR climbs significantly, I would probably move to transplant rather than trying to salvage with another TKI.
Jerald Radich, MD
Clinical Research Division
Fred Hutchinson Cancer Research Center