Question

[B. Greene]

In reading the gentleman’s post from Poland it has made me rather panicky in regard to this hypocellular business. Does this mean that even though you’ve gone through all the chemo etc. that the cells simply can not come back due to this condition and no matter what that’s it, theres nothing to do about it. We are having problems on this trial drug and I know he had to have a certain level of cellular activity before they would accept him on the trial and it was close. Then we get this toxic readings on the CBC and BMB and wonder if this med then does further damage to the marrow. I do know it has messed up his liver.

The Dr. kind of talks around all of this with no answer so thought you might have some thoughts on this. Barbra

[andrzej g.]

Dear Barbra,
There’s nothing simple in medicine and as far as I am concerned the primarily hypocellular marrow does not influence trouble with the cells come back ultimatively. It makes their revival the more difficult the more risk factors (esp. chromosome abnormalities) you have. All of I speculate here is the prognosis and statistics which as you surely know lie in the middle between truth and lie. Every individual course of MDS is unpredictable though all of the data on all of the individual courses taken together make me horrified.
The most up-to-dated info on the disease I founded here:
http://www.asheducationbook.org/cgi/content/full/2004/1/297
http://www.asheducationbook.org/cgi/content/full/2004/1/318 (section III)
My thoughts are with you, Barbra. Keep well.
Respect, Andrzej.

[Suzanne]

Barbra, I asked what I was after reading something & they told me that I was hypocellular. It has never been discussed as anything that changes anything . If I remember correctly it deals with the size of the cells.

[andrzej g.]

As far as I am concerned hypocellularity deals with the amount of the cells in the marrow. If the marrow is hypocellular you don’t have many cells. If you have – suppose – 10% of blasts – it means that you wouldn’t have such a high percentage of blasts if the marrow was normo- or hypocellular. The total blastosis remains still not that high – something just happened (mediating biological factors excreted by neo cells, activation of cytotoxic cells, etc.) within the marrow that would cause apoptosis (death) of the normal cells. There are very restricted data on hypocellular MDS – let me quote: It remains unclear whether patients with very hypocellular marrows may benefit preferentially from immunosuppressive approaches. Similarly, there are no data about the response rate following other types of therapy in patients with hypocellular MDS.

[sarah]

My husbands are hypercellular.Would this be an abundance?
Sarah

[andrzej g.]

I understand being hypocellular is identical to being hypoplastic.
If it had to deal with the size of the cells it would be called ‘microcellular’, I guess. Since your husbands are hypercellular, Sarah, it would mean an abundance. Hypercellular MDS with no chromosomal abnormalities have a better prognosis and better outcomes on BMTs. That’s good for your husband.
Interesting info can be traced also to:
http://www.show.scot.nhs.uk/ngt/bmt/NGHOS-MDS_treatment_strategy.htm
http://www.med-ed.virginia.edu/courses/path/innes/wcd/syndrome.cfm

[sarah]

Thanks Andrzej for the sites. Very informative.
Sarah

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