Totally confused about blood and blast counts

[Debbie W]

My husband had two cycles of decitabine and tretinoin and his counts were improving, the doctor said on 7/13 when she did the follow up BMB that she was expecting good results. I asked her if this was because of the blood counts and she said yes, so when the results of the BMB showed that the blasts had increased to 20% we were taken aback.

Is this typical that they move in the same direction? It appears that blood counts do not matter very much as a measure of the progression of the disease???

Should would ask for a repeat BMB before starting on a more aggressive induction therapy? Seek another opinion?

Any comments would be appreciated, we are waiting for a call back from the doctor.

[Debbie W]

Just some additional information ...

April when he was admitted to the hospital for low hemoglobin level.

WBC - 3.5, HGB - 6.2, PLT - 191

5/24 - day of first treatment

WBC - 3, HGB - 7.5, PLT - 200, ANC 1.1

6/24

WBC - 2.4, HGB - 10.2, PLT - 293, ANC - .7

7/13 numbers

WBC - 1.8, HGB - 11, PLT - 72, ANC .3

He had 2 units of blood the week of his first cycle and then another 2 units and also platelets after the first cycle.

Then he had only one unit of red blood after the second cycle on 7/6 when his hemoglobin dropped to 8.

7/16 numbers

WBC - 2.5, HGB - 11.3, PLT - 111, ANC - 5.3

Initial blasts on 4/26 as read by the local hospital 10%, same slides as read by Sloan 15%.

Second biopsy on 5/20 at Sloan before starting treatment - 13%

Third biopsy on 7/13 at Sloan - 20%

[Birgitta-A]

Hi Debbie,
You know blast cells are immature blood cells and when they increase they tend to take over the space in the bone marrow - there will be less space for maturing blood cells. As you suspect increased blasts often means decreased blood counts.

It is true that the % of blast cells is very important when you decide treatment - perhaps you could get a 4th BMB before you ask for a more aggressive treatment. Too bad that the blasts have increased during Dacogen and tretinion treatment though the blood counts have improved.
Kind regards
Birgitta-A

[Debbie W]

We finally spoke with the doctor this morning and this is one of the questions I forgot to ask about, another BMB! But I did raise this point with my husband after reading your reply to my question and he is not in favor of another biopsy.

She did say that the biopsy is what they need to go by. Just thinking out loud, I wonder if there is a certain small window of time where they both can show improvement (counts) or progression (disease)??? That would raise the question for others of how often a BMB should be done while receiving treatment.

For now, my husband has decided to go ahead with the induction therapy next week and we'll use the balance of this week getting things in order.

It would be an interesting subject to research (the window where both increase) but I'm all googled out for the time being.

I appreciate the reply and all the information and knowledge you have brought to this site.

Best regards,

Debbie

[Birgitta-A]

Hi Debbie,
Thank you for your kind words! Hope your husband will have a positive response to stronger chemo!

You know his counts have not really improved so much. The WBCs have decreased from 3.5 to 2.5 and the platelets from 191 to 111. Only the HGB has increased from 6.2 to 11.3 and that is of cause positive. The ANC number from 7/16 must be wrong because the neutrophils are a kind of WBCs and ANC can never be higher than the WBCs.
Kind regards
Birgitta-A

[Debbie W]

ANC - it should have been .53! At least I know you read the message

The hemoglobin and sometimes platelets (they were up to 293 at one point) improved more than the WBC and maybe that is what I was missing??? His WBC and ANC did increase on Monday, but they never did reach a "new high" after starting treatment. The doctor said it is almost as if the decitabine was working on some level which was good, just not good enough.

He will be admitted to Sloan on Monday for the induction therapy and then hopefully a few weeks or a month later to transplant if all goes well.

Science and math we never strong subjects for me so it is challenging to try and make sense of all this information.

You're welcome and thanks again for your insights.

Best regards,

Debbie

[Birgitta-A]

Hi Debbie,
Good that your husband is young enough for a SCT! Hope everything will function well!
Kind regards
Birgitta-A

[Debbie W]

Thanks, as you imagine it is still scary.

[Birgitta-A]

Hi Debbie,
Yes, a SCT is always a very complicated treatment - I was too old at dx and needed not to consider SCT.
Kind regards
Birgitta-A
71 yo, dx MDS May 2006, transfusion dependent, Desferal and Exjade for iron overload, Neupogen 3 injections/week for low WBCs, Thalidomide and Prednisone for severe fibrosis, asymptomatic