Questions

[Nancy H]

My mother has myelodysplasia and I was wondering if anyone can answer some questions for me. What does it mean when you talk about blasts and how do you tell what level you have?
When she was first diagnosed the doctor said her bone marrow has 3% bad cells. What does that mean?
Her counts are all low. She has had two rounds of Vidaza, seems to need blood tranfusion about every 7-10 days and platelets every 5-7 days. When should she see some improvement or does that just vary from one person to another?

[Suzanne]

Nancy, Do you know what type of MDS your Mother has. Some types are harder to treat then others. Also a lot depends on her age and any other health problems. The usual way to measure blasts is with a bone marrow biopsy although you can have blasts in your blood as well. Blasts are immature cells. The ones that are problems are “funny shaped” as one of my doctors says, and are not going to mature and produce red cells, white cells and platelets like they should. They reproduce more defective cells. Once the blast level hits about 20% they now consider that one has AML-acute Myelogenous Leukemia. Hopefully your mother is under the care of a hemotologist with a lot of experience with MDS.If not she should be or in contact with, or least have a consultation with a “Center of Excellence”for the disease. There are a lot of new developments in treatments for these diseases and it is rare enough that most hemtologists don’t see a lot of it except some elderly patients with a lot of health issues that follow the ‘supportive care’ route.

[Kathryn]

Nancy, my father has CMML and I am wondering about the same things you are. It can be rather confusing. My dad starts his second round of Viadza soon, but hasn’t recovered from the first one yet. I hope your mother sees some improvement soon. Best wishes to you both…

Suzanne, are myelocytes the same as blasts? Last I heard, and it has been a bit, my father’s were at 56%. W/ CMML, would this be considered AML or AMML?

Thanks,

Kathryn

[shirlsgirl]

Hi Kathryn,

Normal bone marrow Aspriate:

%
Blasts
0-5
Promyelocytes
1-8
Myelocytes
5-18
Metamyelocytes
13-32
Neutrophils
7-30
Eosinophils
0-4
Basophils
0-1
Monocytes
0-5
Lymphocytes
3-17
Plasma cells
0-2
Megakaryocytes
0-1
Macrophages
0-2
Pronormoblasts
1-8
Normoblasts
7-32
M:E ratio
2:1-4:1

Marrow examination generally entails a 500 cell differential of all nucleated cells.

Normally, blasts constitute 5% or less of healthy bone marrow. In leukemia, however, these blasts remain abnormally immature and multiply continuously, eventually constituting between 30% and 100% of the bone marrow.

When the blasts count is more than 30%, acute leukemia has taken place.

Hope this helps. Jody

[Kathryn]

Hey Jody, thanks, it definitely clears some things up and confirms my suspicions.

Kat.

[shirlsgirl]

Hi Kat,

Normal wbc maturation is Blast…turns into promyelocyte…turns into myelocyte…metamyelocyte….band form…and finally mature granulocyte. Your Dad’s myelocyte’s may have increased but not necessarily the blasts. Do you know his Blast count? If his blasts are under 30%(or perhaps 20% – I read Suzanne’s post.. I may have old info.)then he would not have AML. What does his doc. say?

take care, Jody

[Suzanne]

The WHO did change the transition point to 20%- maybe a year ago but I went to a talk on MDS last week br Dr Gore Fron Hopkins who said these demarkation lines are sometimes confusing. That some patients do better with treatment for MDS past the 20% point instead of going right to the chemo mode then. Another place where they really have to look at the individual.

[doreen]

Suzanne, Can you explain your last statement a bit more. What do you mean by 20%? All of this information is so overwhelming to me. What type of treatment responds better to MDS over 20%. I wish I could been able to go to that conference that you went to. Thank you for sharing that information with all of us. Regards, Doreen

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