Is this MDS or not?

[Madame]

My husband recently received the results of his bone marrow biopsy and aspiration. The doctor said there was no leukemia or preleukemia, and everything was fine. I asked for a copy of the report on the way out. The first sentence of the final pathological diagnosis is: Normocellular bone marrow with relative erythroid hyperplasia and dyserythropoiesis suggestive of myelodysplastic syndrome.

It is also noted: there is morphological evidence of dyserythropoiesis suggesting a possible myelodysplastic syndrome. However, no increase in blasts is noted and an MDS FISH panel is negative.

I can provide more information if necessary, but based on these two sentences, what is your interpretation?

[Neil Cuadra]

Madame,

Bone marrow reports are written by technicians who use medical terms that give precise information to the doctors, but aren't meant for us laypeople.

MDS is sometimes called "pre-leukemia" so hearing that it's not preleukemia is good news. So is "normocellular bone marrow", which means you have the right number of bone marrow cells. I've never heard the word "dyserythropoiesis" but I can guess that both it and erythroid hyperplasia mean that the process of red blood production is faulty.

The FISH test stands for "fluorescent in situ hybridization" and can detect genetic problems in chromosomes. You passed that test.

Is MDS ruled out or not? I'd be confused by that report too. I think your doctor should be the one to interpret it for you, so you should take the report to your next appointment and ask for an explanation in plain English.

[triumphe64]

And let us know what they say.

[Madame]

Thank you so much for replying! I definitely plan to speak to the doctor about this, but unfortunately our follow up appointment is not until the end of October, so I have lots of time to educate myself (and worry). I'm just surprised that the doctor didn't even mention myelodysplastic syndrome. Seems like there is definitely a red blood cell production problem.

[triumphe64]

Originally Posted by Madame

Thank you so much for replying! I definitely plan to speak to the doctor about this, but unfortunately our follow up appointment is not until the end of October, so I have lots of time to educate myself (and worry). I'm just surprised that the doctor didn't even mention myelodysplastic syndrome. Seems like there is definitely a red blood cell production problem.

Make sure they know to look for Pure Red Cell Aplasia. It is very rare. It took them 3 BMB's to find it for me. They kept saying "bad sample."
Did they do a "retic" test?

[Hopeful]

Hi Madame,

I would try not to panic. The smoking guns for myelodysplasia are blasts, cytogenetic abnormalities and/or significant dysplasia (>20%). There are other conditions that can cause red cell dysplasia, some more easily treatable, like vitamin/mineral deficiencies.

If the BMB report is sparse in interpretation, and you are very worried, another option is to get the slides and bring it to another center for a second opinion.

Best of luck!