8 replies to this topic

[JMGrad]

Hi everyone,

      So I was looking over my pathology report from my bone marrow this past Nov (9months on Sprycel) and this is what it said:

Bone Marrow Diagnosis:

     Bone Marrow, left, clot, aspirate smears:

          Cellular (60%) bone marrow with trilianeage hematopoiesis

Peripheral blood film:

      ABSOLUTE LYMPHOCYTOSIS, (SEE COMMENT)

COMMENT

Correlation with ancillary studies is recommended for assessment for minimal residual disease.

Flow cytometric immunopheneotyping is recommended on peripheral blood specimen to assess for B- or T-cell neoplasm.

Could you please tell me what this means? I did a little Googeling (killer on my nerves) and if I am understanding this right it means that that even though I am having a good response (PCR less that 0.01) the Sprycel isn't able to kill allof the CML? Or that they think I might have lymphoma too? Is that possible? To have leukemia AND lymphoma at the same time? This is making me really nervous because it was Jan of this year that I was first diagnosed...  

[CallMeLucky]

I can't answer specific but with regard to Leukemia and Lymphoma, while it is possible it would be very rare.  And your statement about having a good response but Sprycel not being able to kill all of the CML pretty much sums up the issue with TKI therapy.  Our treatment works well of rmost people at keeping the disease under control, but it cannot kill all of it, so we live with low level disease and that is why we hav eto stay on the drugs indefinitely.

Hope that helps a bit, I'm sure someone with more understanding of this will respond on the details of the wording.

[JMGrad]

Thank you Lucky! I guess I've been reading too many stories of how people are stopping their medications after being on them so long I assumed that would be the (eventual) path for me as well. Just made that ass out of myself huh. Lol.

[Sneezy12]

Hve you discussed this with your Oncologist? Regards, Frank

[JMGrad]

Hi Frank!

    I emailed his PA this morning and she said that there could be multiple reasons for this to include: infection, a reaction to the Sprycel, or another type of Leukemia. I guess they dont think it's a big deal because they never mentioned it to me - AT ALL - when I inquired about my bone marrow/PCR results. February it is...

[Trey]

Your PCR is good so it is not likely associated with the CML.  Lymphocytosis (higher than "normal" levels of lymphocytes such as T-cells and B-cells) is most often caused by illness, sometimes low level ones that you are not aware of.  You did not say how high the absolute lymphocyte count was.  Sprycel can cause unusual T-cell responses in some people.  Normal blood levels change when required to fight a certain virus, bacteria, etc; so "high" lymphocytes is a good thing when they are needed.  Unless you have swollen lymph nodes it is probably not an issue.  Even if you have swollen lymph nodes it could simply be an illness.  Your marrow cellularity is within normal range, so a good sign. The lab report is only suggesting more tests.  It did not find anything specific, but is suggesting tests for worst case scenarios.  I would re-test the CBC in a week or two as the first step. 

A couple of your specific questions:

"if I am understanding this right it means that that even though I am having a good response (PCR less that 0.01) the Sprycel isn't able to kill all of the CML?

It has nothing to do with that.  Sprycel is presumably not able to kill all CML stem cells, but T-cells and B-cells are usually NOT leukemic cells in large numbers in CML.  It is the myeloid cells (neutrophils, basophils, eosinophils) that are more often leukemic in CML.  This is not an absolute, but is the general rule.

"Or that they think I might have lymphoma too? Is that possible? To have leukemia AND lymphoma at the same time?"

More likely that you would be struck by lightning.

[JMGrad]

Thank you Trey!

     My lymphocyte percent was 61.4 and lymphocyte absolute count was 5.46 - my monocytes were up too (percent 9.5 and absolute 0.84). I had been stung by a bee on my foot 2 wks before and I mentioned that to the PA but she still wants me to have the tests - and Im ok with that - because like you said, they are looking at worst case scenario. Soooo when the day comes I'll pop in the headphones and try not to think the worst about it. Thank you all for your help!!

     

   Happy New Year!!

[CallMeLucky]

I don't think that's making an ass out of yourself, I've done much worse than that

I think there is a line of thinking that many of us have that we eventually want to get off treatment - who wouldn't.  But realistically as of now, most of us will not be able to stop treatment.

Your PCR is good and that is key - let them run the other tests, most likely it will be something that resolves itself.

[Trey]

Since your neutrophil percentage is low and your PCR is good, that indicates  it is almost certainly an immune response to an illness, allergen (bee sting?), or such.