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1st week results - I'm already in CHR??

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#1 Happycat


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Posted 14 April 2011 - 08:25 PM

Okay, not that I'm not happy to hear it, but everything about my diagnosis was so weird, it just seems to get stranger and stranger.

My WBC was 42K last week at diagnosis.  The rest of the bloodwork was fine.

However, my blood smear had so many promyelocytes, they thought I must have APML.  Plus, I was bruising very badly (why I got the CBC to begin with), so their initial dx (from multiple docs) was APML.

Much testing later, and a few incorrect results (didn't find the APML 15/17 translocation, then thought they saw an APML-variant 11/17), they finally found 199 out of 200 cells by FISH were positive for bcr-abl.  The lab director thinks the probe for 11/17 just isn't that good, so believed it to be an aberrant result.  They followed up with a karyotype just to be sure, and saw only the CML 9/22 translocation.

They think the bruising was due to high amounts of ibuprofen I was taking and possibly the cortisone shots I had for my neck pain.  (I bruise every time I have cortisone, so it's either cortisone alone or cortisone with ibuprofen doing it to me.)

Still, it bothers me that my blood smear had so many promyelocytes.  Keep thinking it's a sign of more aggressive disease or some strange mutation that will ultimately make me resistant to Gleevec.  Do we ever stop wondering about this???

Anyway, after 1 wk on Gleevec, my WBC was 8.1K, back to normal, with no promyelocytes in my blood smear.

Did anyone else have high promyelocytes (and mainly just those) in their blood?  How weird am I?


#2 Trey


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Posted 14 April 2011 - 09:22 PM

Congrats on reaching CHR quickly.  Regarding the excess promyelocytes, the diagnostic BMB is a snapshot, not a video.  So your marrow may have been in a period of rapid growth, possibly due to the cortisone, and the snapshot showed the high promyelocytes.  Promyelocytes are essentially "teenager" white blood cells.  So they are not blasts (baby WBCs), but rather are a little more mature.  The key is that if these promyelocytes continue to mature, all is well.  If the marrow is stuck in the promyelocyte stage whereby the WBCs grow to promyelocytes but then stop maturing, than that would be a bad sign, and APL might become a consideration.  I would suspect that your BMB just caught the marrow in a specific growth spurt.  The way to know for certain would be to have another BMB at the 3 month point and see if the maturity levels have normalized.  If so, all is well.  If the high promyelocytes continue, then there would be an issue -- but I doubt it.

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