Changes in BMB Results

[rich7]

Hello All,

My previous biopsy from one year ago showed 30-40 percent cellularity, slight dysplasia and 5q deletion. This new biopsy shows no 5q and the following. Any advice or guidance is appreciated!

Adequacy: Limited. Much of the intertrabecular space is empty.

Cellularity: 30% Hypocellular for 41 yrs old.

ERYTHROPOIESIS: Unremarkable
GRANULOPOIESIS: Unremarkable. Increased eosinophils.
MEGAKARYOCYTES: Present
LYMPHOCYTES: Hematogones identified

CLOT SECTION: Fragments of marrow that are 30% cellular with trilinear maturing hematopoiesis. Megakaryocytes are slightly reduced in number. Eosinophils are increased. An iron stain is positive.

Immunophenotyping by flow cytometry (H19-126) shows that a subset of monocytes expresses CD56. Blasts are not increased, and no lymphoma or leukemia is detected.

BONE MARROW:
- SLIGHTLY HYPOCELLULAR MARROW WITH TRILINEAR MATURING HEMATOPOIESIS
- DIAGNOSTIC FEATURES OF A CLONAL MYELOID DISEASE ARE NOT SEEN
- SUBSET OF MONOCYTES POSITIVE FOR CD56 (SEE NOTE)

NOTE: Although this finding is abnormal, it may be seen in some regenerating or reactive marrows. Its clinical significance in this case is uncertain.

[Hopeful]

Hi Rich,

Although your marrow is hypocellular for your age, it is doing a good job of producing normal blood cells. So all is good there!

Look for a cytogenetic report to see if you still have a 5q deletion. It wouldn't show up in flow cytometry report.

Are your counts fine?

[rich7]

Thank you! My WBC hover around 3.5-4, RBC around 5, and platelets around 200. Actually, I just got word that the molecular analysis report will take 2-3 more weeks and I assume is what shows level of progression of dysplasia? The cytogenetic testing showed no chromosome abnormalituies using FISH.

My concern also was the CD56 and hematogones present? Also report stated "Adequacy: Limited. Much of the intertrabecular space is empty."

[Hopeful]

Dysplasia would have shown up in this flow cytometry report. It indicates only slight dysplasia. So, from an MDS point of view, this all looks good!

I tend to think that "Adequacy: Limited. Much of the intertrabecular space is empty." means that they got a bad BMB sample. Maybe they got a pocket where there weren't as many cells to analyze as would be desired. This can happen if your marrow is hypocellular. I use to get "inadequate sample" mentioned all the time on my BMB report :) I don't think you have to be worried about this statement.

I don't know the significance of CD56 and don't see mention of hematagones. I am guessing that the molecular report may shed some more light on this if it looks for gene mutations or cytogenetic abnormalities besides what was checked with FISH.

[rich7]

Thank you, Hopeful. Report states:

MEGAKARYOCYTES: Present
LYMPHOCYTES: Hematogones identified

I’m wondering if it’s not MDS, my lupus diagnosis is to blame for the bone marrow issues etc. Thoughts anyone?

[rich7]

Lymph Cluster: Blast Cluster:
% of gated cells: 22%
1%
CD45: Bright Dim
CD34: Subset CD117:
Subset HLA-DR: Positive
CD38: Positive Positive
CD123:
Negative
CD56: Subset Negative
CD16: Positive
CD11B: Positive

LYMPHOID (T-CELL): Lymph Cluster:
Blast Cluster:
CD2: Positive Negative
CD3: Positive Negative
CD5: Positive Negative
CD7: Positive Negative
CD4: Subset
CD8: Subset Negative
CD4:CD8 Ratio: 3.64
Negative
CD25: Negative

MYELOID: Lymph Cluster:
Blaster Cluster:
CD13: Positive
CD33: Positive
CD15: Negative
CD64: Negative
CD14: Negative
CD36: Subset

LYMPHOID (B-CELL): Lymph Cluster:
Blast Cluster:
CD19: Subset Negative
CD20: Subset Negative
CD10: Negative Negative
CD5+/CD19+: Negative
Negative
KAPPA+/19+: Subset
Negative

Flow cytometry shows that a subset of monocytes express CD56

What does all this mean?