Peripheral Blasts vs. BM Blasts

[Russ P.]

I was dx’d with AML (developed from MDS) in a BMB on 1/08/07. I had 35% blasts in the marrow and 46% in my periperal blood. A month ago another BMB was run (before my 3rd rd of PDX-101+Vidaza). This time my marrow blasts had dropped to 15% but my periperal blasts were 82%. I can’t get an answer as to why from a hemotologist. I’m happy with the improvement in marrow but hope someone out there can tell me why the blasts in the blood are so high.
Russ

[patti]

Russ,

Generally, the higher the blasts in the peripheral blood, the higher they are in the marrow. Blasts don’t show up in the perihperal blood until they get so high in the marrow that they “spill over” into the blood. So your counts almost don’t make sense. My first thought is someone read the results wrong on the CBC? I would really push for an answer on this because it DOES matter in terms of how well your beating (or not) the AML. Push back. Hard and fast. You do not want things to get out of hand.

God bless,

patti

[Russ P.]

Patti,
Thanks for the reply. It is really great that you have stayed up with the forum as your expertise in this terrible disease has been helpful and inspirational. I can imagine that it is difficult for you to relive your struggle in caring for your loved one by reading about the battles of others. I saw my regular hemo/onc today and he doesn’t have the answer either but felt I should be cautiously optimistic about the lower marrow blasts. I have had a dozen or more CBCs since the BMB and the peripheral blasts run 55-60% so I suspect the 82% to be a fluke. I am thankful that I feel as well as I do with what I got. (Mostly a little nausea, fatigue and paranoia about getting an infection.)
May our God of mercy and grace wrap you in His love.
Russ

[chuckk333]

I WAS TOLD BY THE PATHOLOGIST WHO DID THE FIRST BMB THAT “BLASTS ARE IMMATURE CELLS AND THEY OCCUR IN NORMAL BONE MARROW TO SOME EXTENT (UP TO 5%)AS PART OF THE NATURAL PROCESS OF PRODUCING
NORMAL BLOOD CELLS” SEEING THEM IN THE PERIPHERAL BLOOD SMEAR IS NOT NORMALL.

CHUCK

[jga_socal]

My understanding is that what is observed in the marrow will be observed in the peripheral blood 2-4 weeks later. If your marrow has suddenly improved, your p. blood will soon follow as the excess p.blood blasts die off.

[Russ P.]

Thanks for the replies. On the same day of my BMB, I had a CBC which showed 60% blasts in the blood – a big difference from what the pathologist had. One month later my CBCs are still showing 55-66% in the blood. The pathologist’s comment on the BMB was: “The marked descrepancy between the blasts in the periperal blood (82%) and those in the bone marrow (15%) is noteworthy,” Too bad he didn’t elucidate.
Russ

[Russ P.]

I sent a query regarding the high peripheral blasts and the reduced marrow blasts to Dr. Aza Raza at the UMass cancer center. Here is her answer: “This usually means that blasts are coming from an extra medullary site (outside the bone marrow). It could be that there is more disease activity now in the spleen or the lymph nodes. I would advise a work up for that with CT scans.”
This doesn’t sound good but I credit Dr. Raza with her quick reply and having a possible answer.
Russ

[Russ P.]

This is an update on my CT scans.
My prior post: “I was dx’d with AML (developed from MDS). In a BMB on 1/08/07, I had 35% blasts in the marrow and 46% in my periperal blood. A month ago another BMB was run (before my 3rd rd of PDX-101+Vidaza). This time my marrow blasts had dropped to 15% but my periperal blasts were 82%.”

Dr. Raza felt the high periperal blasts were from outside the bone marrow and suggested a CT scan to check the spleen, lymphnodes and liver. The CT scan was negative for any neoplasia but Dr. Raza said
the spleen could still be the cause.
Russ,

[Author]

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