Hypocellular MDS

[MDSPerth]

Hi, is there a knowledgeable person that can help clarify the following for me please. I understand that Hypo is too little and Hyper is too much, but is Hypocellular MDS what most people have? We seem to have had an issue getting Pauls haemo to slot him into a category - ie RA etc. - haemos comment is he does not neatly fit into any one category, or is Hypocellular MDS a category in itself?

In the letter the specialist wrote to Pauls GP he put his diagnosis as Hypocellular MDS; Intermediate 2.

Any comments that can make it clear would be appreciated. Thanks

[AngieA]

I think the hypocellular is uncommon. I was hoping you would get some response on this as it is same type my husband has. His docs as well have not "classified" his type. He also has the trisomy 8 chromosone. But no other abnormalities.

He's just finished 6 months of dacagen with no response so we are in a temporary rest periond so to speak. We are considering our options

I wanted to ask you...I am not familiar with some of the abbrevations in your signature line. What is EPO and G-CSF...and what do you mean by a "good response"?

Sorry I can't be of more help with your question.

[Hopeful]

Hypocellular marrow is rare for MDS. It is not a unique classification. So, a patient can be RA, for example, with a hypocellular marrow. A hypocellular marrow is more common in "younger" MDS patients (under 70). It is easy to confuse with aplastic anemia and also is more likely to respond to immune suppressant treatments.

AngieA, if your husband only has trisomy 8 and has a hypocellular marrow, you should discuss with his doctors trying immune suppressant therapy (ATG/Cyclosporine or Campath). Trisomy 8 is thought to be another marker that an immune attack is occurring. So, he may be a good candidate for the treatment.

[Birgitta-A]

Hi Sandi,
Hypocellular bone marrow means too few cells in the bone marrow according to the patient's age. Hypercellular is more common in MDS as Hopeful wrote. As far as I understand the cellularity has no prognostic value – I have hypocellular myself.

Paul’s doctor is using the IPSS for MDS (International Prognostic Scoring System)

They look at
1) % of blast cells in the bone marrow: <5% score 0 5-10% score 0.5 11-20 score 1.5 and 21-30 score 2

2) Karyotype: Good score 0 Intermediate score 0.5 and Poor score 1

3) Cytopenias: 0-1 score 0 2/3 score 0.5

Karyotypes means chromosome types
Good: normal, -Y, del(5q), del(20q). Poor: complex (≥ 3 abnormalities) or chromosome 7 anomalies. Intermediate: other abnormalities.

Cytopenias
means low counts for example Hemoglobin <10.0, Neutrophils (a type of WBC) <1.8, platelets <100

Low risk 0
INT-1 0.5-1.0
INT-2 1.5-2.0
High risk ≥2.5

Kind regards
Birgitta-A
73 yo, dx MDS Interm-1 2006. Good results with Thalidomide + Prednisone since 2010

[cdseibold]

I have been reading a hematology book. The chapter on MDS states that hyper cellularity is characteristic of MDS and hypo is characteristic for AA.
But I don't think either is a smoking gun. For MDS the aplastic (unusual) cells and genetic information are the important factors.

Also I have never found anyone to state what the normal variability about the age adjusted cellularity is? Every number has a range that defines normal.

Thoughts, others?

[Sally C]

Hey Carol,
This is not going to help at all with your understanding of all this. It's just something to put in the mix of these crazy diseases.
My husband has MDS. He started out hypocellular in the spring of 2009 which, along with other factors, made it very difficult to get a firm diagnosis of MDS vs. AA. He then went hypercellular and now is back to hypo. He is almost 67.
I wish you well.
God Bless,
Sally

[MDSPerth]

Thanks everyone for your responses. The original findings from the BMB favoured AA with a differential diagnosis of hypoplastic myelodysplasia with cytogenetic studies required. Unfortunately those cytogenetic studies revealed a number of the cells tested containing monosomy 7 and trisomy 8 which is consistent with MDS. Only 7 of the 20 cells presented with no abnormality.

Angie - G-CSF and EPO are growth hormones which are administered by injections. The G-CSF is to stimulate the WBC and Neutorofils and the EPO is to hopefully stimulate the RBC and Haemoglobin. (EPO is one of the ones that Lance Armstrong the cyclist is in trouble for only Paul has it under script). After reading a number of articles it appears that maybe only 35% of patients show response to these meds and Paul is one of the lucky ones in that it has raised his counts very well - ie HGB from 94 to 122 and neutrophils from .35 to 2.7. Where we are very aware that these drugs are not a cure and are only a bandaid they at least keep Paul non-sympomatic to the disease and improve the quality of life whilst he awaits hopefully for a marrow match and can proceed to transplant.

Can anyone tell me in lay terms what it means if erythroid nests are prominent?

[Birgitta-A]

Hi Sandi,
Erythrocyte means red blood cell. I think that erythroid nests mean several immature red blood cells in the same "nest". I don't know if it is a positive ssign or not. It is not a common expression.
Kind regards
Birgitta-A