Bone Marrow Injury?
 

I do not have a diagnosis of MDS, but am living with depressed bone marrow function from previous cancer treatment. In 2013/2014 I had a total of 67 radiation treatments and 15 rounds of platinum-based chemo. My last chemo was over a year ago, and my last radiation treatment finished in Oct '14.

My marrow has never fully recovered to pre-treatment levels, and I'm beginning to wonder if it will. I'm under the impression that secondary cancers due to radiation and chemo take years to develop. I guess my concern is when does depressed marrow function cease to be "from chemo/rad" and begin to be from something else? And how would I know?

My latest labs (8/7/15)

WBC: 3.0. L
RBC: 3.69 L
HgB: 12.5
HcT: 37.4
MCV: 101.4 H
MCHC: 33.4
RDW: 15.1
Plts: 67 L
Bands: 0
Granulocytes: 2
Lymphocytes: .6 L
Monocytes: .2
Eosinophils: .1
Basophils: 0
Vitamin D (6/5/15) 21
Magnesium (6/5/15) 1.3

Is there any real reason for concern given that these are typical values and not improving over time? My platelets haven't been over 100 since August of 2014, and typically range from 65-75. WBC are normally 2.7-3.2. The last time they were within normal range was 9/14.

I am taking Vitamin D supplements. It has come up from an initial level of 10 in May.

I guess my main question is should I pursue further diagnostics with my Onc, or is this very typical post chemo/rad bone marrow behavior? Last year, when my platelets were hovering around 22-23, they assured me they'd soon be back to normal, but it really never happened.

Thanks in advance for the collective knowledge and insight on this board!

Hi Jcc,

You have certainly been through a lot without one more thing to worry about.

It looks like you are still Vitamin D and Magnesium deficient. Have you been tested for other things like iron, B12, and folate? All of these vitamin and mineral deficiencies can impact the marrow's production of healthy blood cells.

I do not have experience with secondary MDS, but it does seem possible that the chemo/radiation could also cause some stem cell loss/damage, in which case, your counts may never fully return to normal.

Only a BMB can tell for sure what is going on. A BMB can tell if you have signs of bone marrow failure by looking at cellularity, blasts, chromosomal abnormalities, and dysplasia. I would consult a hematologist just for the peace of mind! Hopefully, they will find nothing concerning. Best of luck!

Like Hopeful said, a bone marrow biopsy will help figure it out, also you do need more magnesium, it should be 1.9-2.1, not 1.3.

A friend of mine had chemo for breast cancer several years ago and her platelets have never gotten above 80k since. However, low platelets (particularly above 50k, not like the low levels you ordinarily see on this board below 10k) are easier to live with than low white blood cells.