Quote:
Originally Posted by Greg H
It's really great that you are looking out for your Dad.
Like Zoe, I am very curious about the chromosomes, as well as whether he has a PNH clone, hypocellular marrow, and/or is HLA-DR15 positive. Also the blast count. Do you know his IPSS score?
Younger folks with MDS sometimes respond well to immunosuppressive therapy [IST] using ATG and Cyclosporine, and all of the things I mentioned have shown up in one study or another as possible markers that indicate a good probability of response to IST.
Birgitta is more up to date on the Vidaza studies than I am, but the initial work that got it approved for use in the US was on higher-risk patients (i.e., lots of blasts, bad or multiple chromosomal abnormalities, multiple cytopenias). Despite his frequent need for transfusions, I'm wondering if he's high risk or not?
Can you give us a little more info from his BMB reports?
Take Care!
Greg
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Apologize for my elementary knowledge of reading BMB's and BMA's. Which is why I have posted the reports below -
"
Test: Histopathology Examination
Specimen type: Bone marrow trephine
Microscopy : Sections show a linear core of bone marrow which is hypercellular. The myeloid and erythroid ratio is markedly increased. There're sheets of eosinophils and their precursors. The erythroid series is markedly decreased. The megakaryocytes show dysplastic features with micro-megakaryocytes, monolabated megakaryocytes with occasional dysplastic ones.
There is no evidence of increase in blasts or ALIP.
There is a mild increase in reticulin fibres (grade 1).
Diagnosis: Bone marrow biopsy- Hyper cellular marrow with an increase in eosinophils (see description) Over all features are of a low grade myelodysplastic syndrome."
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"
Peripheral Blood picture report -The red cells appear mildly hypochromic. Show oval macrocytes, tear drop shaped cells and contracted cells. The white cells show leucocytosis with an eosinophilia, neutrophil left shift with some blast cells and dysplastic changes in the neutrophils such as hypogranularity and hypoloburity. A cell count on 200 cells revelaed 2% myeloblasts (No Auer rods detected), 16.5% monocytes(promonocytes-4% added to this count), 10% eosinophilis, 23.5% lymphocytes. The platelets are reduced and hypogranular.
Comment:The features are of a myeloproliferative disorder and of a myelodysplasia.
Bone Marrow aspirate report - Indicate for bone marrow examination - To investigate leucocytosis with dysplastic changes
Aspirate - Difficult from the RPIC
Fragments - One or two, densely hypercellular
Cell trails - Normocellular for age
M:E Ratio 10:1
Erythropoiesis - Markedly depressed. Normoblastic with some megaloblastic changes. Show mild dyserythropoiesis and some cells show poor haemoglobinisation.
Granulopoiesis: Normocellular with giant metamyelocytes, show dysplastic changes and a marked eosinophilia. The myeloblast consist of 3% nucleated marrow cells.
Megakaryopoiesis: Appear normal in number and show small round forms, monolobalar forms and separate nuclei in some cells
Plasma cells: Appear normal
Lymphocytes: Appear normal
Other cells: None
Iron stores: Increased. Show ringed > 15% sideroblasts (As erythropoiesis is depressed only about 55 cells and 33 cells counted on separate counts and gives>15%. A total of 100 cells was not counted in one differential count for ringed sideroblasts)
Diff:
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NRBC: 8.7%
Blasts: 3.4%
Promyelocytes: 05%
Myelocytes: 8.7%
Metamyelocytes: 1.2%
Neutrophils: 23.7%
Monocytes: 9%
Eosinophilis: 23.7%
Basophilis: 00%
Lymphocytes: 12.5%
Plasma cells: 00%
Other cells: 00%
Comment: The features are compatible with a myelodysplastic syndrome - refractory anemia with excess blasts type 1. Surface marker study - Scanty blasts gated show myeloid phenotype. (Blasts are positive for CD34, CD117, CD33 and CD13). "