Reading a BMB Report 101

[Sue&Dave]

My husband has had between 8-10 BMBs since dx in 2015. Of course the first thing we look at are the blasts, then spend some time googling the various results, and promptly forgetting the meanings shortly thereafter! Is there a resource out there that explains the meanings of the terms, what is considered 'normal' and trends to be on the lookout for? In other words, cliff notes for a biopsy report?

[bailie]

I have had 24 BMBs since diagnosis. I keep the information of each BMB and have them in order. I do that to spot trends. I, like you, look up any terminology that is unfamiliar and copy and paste the information on a separate document that is always available. Then any questions I will ask the doctor on the next appointment. As you suggest, it seems the blasts and gene mutations are always the first items to be noticed.

[DanL]

Some of the other items outside of bone marrow blasts and cytogenetic abnormalities include:

cellularity - basically how dense the marrow is. Hypercellular means more cellular, or more dense, than expected, normocellular - about what is expected, hypocellular, less density than expected. Most MDS patients are normocellular to hypercellular, although about 1/4 of cases are hypocellular.

Basically, hypercellular marrow is too dense to let new cells out and may represent cell destruction in the marrow from the improperly formed cells, hypocellular means that there is not enough marrow present to produce enough healthy cells

rule of thumb is that you take your age from 100 and that is what the expected cellularity would be - in my case, I am 43, so the expectation would be between 50% and 60% cellularity.

Myeloid to erythroid ratio or M:E - basically a ratio of early white blood cells to early red blood cells - normal is 1.2:1 all the way to 5:1.

CD4/CD8 ratio - normal is 2:1. Low means a reduced ability to fight infections, Higher means the immune system is either really fighting something or just stronger than normal.

Marrow Fibrosis - sometimes measured as MF-1, MF-2, MF-3, or mild, moderate, or severe is a reflection of scarring of the bone marrow. Most MDS cases have little to no marrow fibrosis. The lower levels MF-1 and MF2 are reticulin fibrosis, MF-3 represents a hardening of the marrow into collagen strands.

Reticulocyte count - basically how many immature red blood cells are in the marrow - .5% to 2.5%, but is higher in patients with anemia as the marrow is trying to put out more red blood cells.

Granulocyte count - basically how many developing white blood cells are being produced - this includes neutrophils, monocytes, basophils, lymphocytes, etc. They differentiate later in the process.

Dyspoesis - simply means misshapen cells
Myeloid cells may be referred to as hypo or hyper granular
Megakaryocytes - a fancy name for platelets

Generally, the only cells that should have nuclei are the white blood cells, platelets and red blood cells should not be nucleated nor should they have multiple lobes, be teardrop shaped (anisocytosis), nor listed as ovalocytes.

In the peripheral smear, they look for Nucleated Red Blood Cells (NRBC), which are basically treated as a red blood cell version of a blast, metamyelocytes, promyelocytes, and myelocytes, which are all immature white blood cells that were released into the blood stream before being ready to function. Segs/Bands are normal white blood cells.

The peripheral smear should not contain plasma cells.

CD34+ cells are basically considered blast cells -

CD as a list of items are just checking for various proteins that may be reactive.

cytopenias simply refers to a reduced number of platelets, red blood cells, or white blood cells. Pancytopenia means that all three are lower than expected.

This is by no means exhaustive, and I am not a doctor, but this is my understanding of the items that show up pretty commonly with MDS patients.

Hope it helps.

Dan

[Cheryl C]

That is so helpful, Dan. Thanks from me too!

[Sue&Dave]

Thanks Dan. This is super helpful and I'll be sure to keep it close by for future reference. I continue to be amazed at the knowledge and compassion of my fellow board posters!

[Meri T.]

awesome.
thanks dan.
meri

[Rebecca K]

Thank you Dan-- I agree, this is very helpful.

I am 103 days post SCT and hypocellular at 10%-- didn't realize until your post that hypercellular is more common! My hemoglobin low (8.5 with weekly transfusions) and doc thinks hypocellularity the prob because I do have engraftment of all 3 lines. She says to stay patient-- that time will raise the cellularity and the RBCs will kick in. Is this your understanding of cellularity?
Otherwise much is good and I am grateful - no GVHD issues, strong and stable WBC and platelet counts. Good metabolics.. Don't want to complain but low hemoglobin is tough to deal with...

Rebecca K

[DanL]

Rebecca,

I was hypocellular for quite a while after transplant and eventually got back to normal. I think that it took me over a year but, i did have a brief relapse during that time which may have been responsible. When I said that hypercellular was more common, it was referring specifically to MDS patients, not the population as a whole. In general, people should be normocellular.

Good to hear that you are doing ok with the transplant. Hopefully the cellularity will rise.

Dan

[Rebecca K]

Thank you Dan. Were you transfusion dependent during the low cellularity? Did you have a SCT? Glad to hear you have bounced back from your relapse!