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Immature granulacites in CBC

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#1 Chrisrap1


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Posted 10 March 2017 - 10:17 PM

Have been on Tasigna for 6 years 3 years in I have immature granulacites start to show. All my labs show CML is undetectable. My wife who is a NP has questioned every time they are there and our local oncologist always assured us they were fine.

We now have seen Dr. Mauro at Memorial Sloan Kettering who says they should not be in there at all. My next move is a bone marrow biopsy.

#2 Red Cross Kirk

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Posted 11 March 2017 - 01:57 AM

I don't think they've checked my blood for those since the last BMB 3½ years ago, just chemistries and counts and of course PCRs. 


I stand corrected: just checked my CBC history and it showed IMMATURE GRANULOCYTE# 0.01,

  0.00, 0.01, 0.04, 0.03, 0.00, 0.01, 0.01 K/cu mm

 Standard Range 0.00 - 0.03 K/cu mm


The doc hasn't remarked on those numbers.  How high have yours been?



09/2012  p210 transcript 118.7% IS @ Dx, begin Gleevec 400mg/day
12/2012  3.59% & bone marrow biopsy - no residual myeloproliferative features but detected 1/20 metaphases containing the Philadelphia chromosome
2013  0.914%, 0.434%, 0.412%
10/2013  0.360% & bone marrow biopsy - normal male karyotype with no evidence of a clonal cytogenetic abnormaltiy
2014  0.174%, 0.088%, 0.064%
2015  0.049%, decrease to 200mg/day, 0.035%, 0.061%, 0.028%
2016  0.041%, 0.039%, 0.025%
2017  0.029%, 0.039%, 0.070%, 0.088%

#3 cmljax


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Posted 11 March 2017 - 08:10 AM

Here's my short history of immature granulocytes:

At Dx - myelocytes 4; metamyelocytes - 3.1 

Switch to Mayo Clinic for rest labs - started Tasigna 600 MG 10/6/16-Mayo results for immature granulocytes:

10/17/16 - 0.50%

10/24/16 - 0.20%

10/31 & 11/14/16 - 0.00%

11/28, 12/15/16,12/28/16 & 1/27/17 - 0.20%

3/10/17 - 0.00%


I too was concerned when I went form 0.00% to 0.20%, but my oncologist at Mayo Clinic said "No problem, as the marrow regenerates, some immature cells can be seen in the circulation." Add to that that the Mayo Clinic lab result says the normal range is 0.00% - 3.0% and I have stopped worrying about it.  Note my numbers are a percentage and Kirk's appear to be absolute.


If you are PCRU, I don't really understand what a BMB is going to show.  It will undoubtedly show that your have achieved CCYR. I would never pretend to argue with any doctor, let alone one at Sloan Kettering, but my experience at Mayo has been quite different.


I would have same question as Kirk - what is your actual reading?

Dx 9/26/16 WBC 28800; platelets 749; FISH 97% PCR 43%

Tasigna 600MG per day

October 2016                     PCR 22% IS

November 2016                 PCR 5.8% IS

December 2016                 PCR 0.1% IS  MMR!!

March 10, 2017                 PCR 0.006% IS  MR 4.22

Tasigna 450MG per day

April 5, 2017                      PCR <.003% IS

June 5, 2017                     PCR <.003% IS (dose reduction validated!!!)

Tasigna 300MG per day starting June 15, 2017

6-day drug break starting June 20, 2017 due to multiple AE's

July 24, 2017                     PCR <.003% IS

September 18, 2017          Negative, AKA PCRU

Tasigna 150mg per day starting 9/18/17

October 30, 2017               Negative

December 11, 2017           Negative

#4 Trey


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Posted 11 March 2017 - 10:14 AM

This is not necessarily a problem when the levels are low.  And it could be more of a low blood count issue than a leukemia issue.  Since Chris is PCRU it is almost certainly not a problem unless the levels are above maybe 3% or so (roughly).  And remember, if the neutrophil counts are low, the relative neutrophil blast count will be automatically higher since it is compared to the total number of neutrophils you have.


A person cannot live for long without immature blood cells.  That is because there must be a constant rebuilding of the blood supply, and those immature blood cells "grow up" into the working blood cells which the body needs.  A more technical explanation is these immature blood cells must divide a number more times before they make the final level blood cells.  So everyone must have immature blood cells.  These immature white blood cells are called blasts, and there are several levels of them depending on how close they are to maturity.  Blasts are only truly a problem when they are leukemic, otherwise they are just normal cells in the wrong location. 


However, these immature blood cells normally should remain in the marrow until they are mature.  That is because they cannot function well to do the work of mature blood cells, so there is no reason to have them in circulation.  Blood cells can also be made in the spleen (extramedullary hematopoiesis), and these blood cells can more easily get out into the circulating blood.   Also, the circulating blood supply is a harsh environment and they cannot survive well out there. 


The main reason people have immature blood cells in the circulating blood is they are "neutropenic", meaning they have low neutrophil white blood cell counts.  This forces the marrow to kick them out early into circulation to try to help do the work even though they are not ready. 



When someone has leukemia which is not under control, the blasts in circulation are usually leukemic cells, and that is a problem.  If the blasts are not leukemic, that is not so much of a problem except that the body is wasting its rebuilding blood cells.  Since you are PCRU, the circulating blasts probably are not leukemic.  So this is not a leukemia problem, but it can be a "disorder" if enough immature white blood cells are being kicked out too early into the circulating blood.


So overall the issue does not show anything about the leukemia itself.  These are likely non-leukemic blasts being kicked out into circulation too early due to low neutrophil blood counts or some other issue.  And we are not all alike.  Some people just have low level "issues" (disorders, autoimmunity, etc) which cause this and would never know it if they did not have leukemia and the associated constant testing.

#5 JoshLee



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Posted 17 March 2017 - 01:55 PM


Some labs have a category for these and some don't. When I lived in Miami my lab picked them up sometimes, but then when I moved home there was no category and subsequently they never showed up. It's not possible that once I started going to a different lab that they just never appeared. If you're under the limit specified on the sheet then you are fine. I spent days worrying about those things and they are probably just cells that are a little yoUnger than normal because your body is trying to keep up with a drug the suppresses your marrow. Don't spend another second worrying about them.

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