Circulating Blasts

[Sue&Dave]

What part of the differential blood counts shows circulating blasts? Are these of any significance for MDS still in watch and wait mode:

ABS segs .63
ABS bands .18
ABS lymphs .65
ABS monos .22
ABS eos 0
ABS basos 0

Or am I looking in the wrong place?

[bailie]

My peripheral blasts are tested with a separate vial and test. My circulating blasts are measured with my BMB testing ("Leukemia/lymphoma markers").

Circulating blasts are a very important measurement for MDS and AML.

This probably doesn't answer your question.

[Sue&Dave]

You're right Bailie, I meant to say peripheral blasts. My understanding is that can give you an idea on how the disease is progressing without having to have a BMB each time.

[bailie]

Sue, it is my understanding that peripheral blasts are hopefully at a lower percentage than blasts found in the marrow. "The diagnosis of leukemia and MDS is based on BM blasts because, in most cases, the percentage of blasts is higher in BM than in PB".

http://www.nature.com/leu/journal/v1.../2403876a.html

I get my labs done at two different locations. My doctors want me to have the peripheral blast measured at just one of the locations for consistency. I often have the PB tests done halfway between my BMBs.

[JordanN]

Hi, Sue&Dave,

I think that different clinics, hospitals, and independent labs report blood work results differently, and you should probably ask your doctor where to find that information on your specific lab report.

Having said that, the peripheral blasts were reported on my dad's results under the heading of "white cell differential" where the percentage of neutrophils, lymphocytes, etc. are listed.

Just like everything else in MDS, circulating blasts can be very variable among different patients. Some patients with stable disease have some blasts peripherally while others do not. However, it seems that the bone marrow blasts are a more accurate estimate of disease progression than peripheral blasts.

My dad had never had more than 1 or 2% peripheral blasts and only when he had an infection until his disease started to progress. In his case, since there were no other treatment options, the doctor chose not to put him through another BMB and relied on the changes in his WBC and peripheral blasts to gauge the progression of his disease. He also sent a sample of his blood to a different lab to get a definitive AML diagnosis from a blood test rather than the BMB.

I'm sorry that you and your husband are having such a difficult time and truly hope that everything improves for both of you soon. I'll be hoping and praying for good news for you soon!

[maggiemag]

This does get confusing, doesn't it?? I could be wrong, but it is my understanding that peripheral blasts are circulating blasts, versus bone marrow blasts. I thought that peripheral blasts are determined by a manual differential, where a smear of blood is put on a slide and examined by a pathologist or tech, whereby an automated differential is run by a machine. The manual is more accurate of course. This is how they see things like oddly shaped cells like ovalocytes, or burr cells or nucleated RBC's or anisocytosis, etc. My ANC can vary by as much as 0.3 on the manual vs. the machine. It is also my understanding that the presence of peripheral blasts is a negative prognostic factor. Possibly some labs always run a manual diff, while my heme/onc's office does an automated diff at the office,and then sometimes sends off a manual which is ordered separately.

[DanL]

Some automated differential analysis machines can produce results for circulating (peripheral) blasts. The accuracy ranges from 28-99%, so accuracy may be in doubt, but if the machine picks up anything, it may show a trend.

[Care.]

Hello JordanN,

Your information is insightful and timely with respect to my Dad's circumstances. He, too, has MDS RAEB-II (dx 11/15, as RAEB-I and transitioned to RAEB-II as of 09/16). He underwent 4 cycles of Vidaza (12/15 - 03/16) then took 6 months off. He started Vidaza again in mid-September 2016, and very few glimpses that the Vidaza might be working have been seen. More notably, however, is that he is tolerating the Vidaza less and less, and he requires more time (an additional week) in between cycles. And he does show 0-2% peripheral blasts.

My question to you is what did your father's CBC's and general health/circumstances look like that led you and his hematologist to believe he had transitioned to AML?

The reason I ask is because my Dad, who lives with me, is so ill (sleeps throughout the day, appetite is much decreased/losing weight/mouth sores, wheelchair/scooter dependent due to joint/bone pain/fear of falling, foggy thinking, etc; which don't improve much between vidaza cycles) and yet his hem/onc is not even talking about doing another BMB--nor would I want to see him go through it if there are strong indicators that he's already transitioned.

Going down this journey with my Dad, I feel that I may be overly optimistic and may be becoming as blind to progression indicators as he is. I seem to be redefining what a "good day" for Dad is with each passing Vidaza cycle.

Care.

[JordanN]

Hi, Care!

I'm so sorry that you are having to go through this illness with your dad. You sound like a wonderful daughter, and I'm sure you are a great help and comfort to him. You are so right about getting used to seeing your once very active parent operating at a much lower level, and of course, hoping every little thing is a change for the better and not a sign that things are getting worse.

I know every patient is different and can have many other conditions that affect how this disease progresses or is treated, but for my dad, his condition was very constant, and when his disease began to progress, it became very obvious very quickly that things were changing for the worse.

My dad's CBC's, bone marrow blasts, and activity levels followed very predictable patterns throughout his illness. His numbers were always very low, never improved without transfusions, were very negatively impacted by Vidaza, but did all of these things in a very narrow set of ranges and at very specific time intervals.

My dad actually had a BMB in June 2015 that showed his bone marrow blasts were still at 18% like they were at diagnosis. That seemed like good news and we thought things would continue as they had been for the last year. However, the first sign of trouble was his CBC in mid August which showed an actual increase in his Hgb and WBC but also the presence of peripheral blasts and nucleated RBCs. For a couple of weeks we were hopeful that this was a sign that Vidaza was finally working, but we soon realized that the bad numbers (and even the good ones) were increasing too quickly and too far beyond the normal range to be a good thing. My dad's WBC and peripheral blasts doubled every 4 to 8 days (he had blood tests twice a week throughout his illness), and it only took a few weeks to go from a WBC of 1 to a WBC of 30 and peripheral blasts from 0 to 65%. At that point, his doctor decided to have a special blood test done to confirm AML rather than put my dad through another BMB especially since his age precluded him from any other treatment options. It was also at this point that my dad started to get one infection after another with no relief from antibiotics.

My dad's doctor was a reluctant question answerer, but as I was my dad's sole caretaker, I really needed to know what to expect. I hope your dad's doctor is open to answering your questions and addressing any concerns you have. As I said, everyone is different, and I hope your dad is stable for a long time to come! You will definitely be in my thoughts and prayers. Hugs to you, too!

[Care.]

JordanN,

Thank you for explaining the CBC trending and changes that you experienced. I realize everyone is different, and I'm finding that my Dad has/had incredible ability to bounce back from vidaza-caused lows, where he would show significant improvements by the end of each 5-day treatment; but during the last 5 vidaza cycles, we're not seeing any improvements without transfusion support. And those are temporary.

Thank you for your prayers!

Care.