Todd discussed changing our local oncologist and she said that was fine. She said she wanted to schedule the bone marrow biopsy for next week. While we were under the impression that she originally wanted to do the biopsy to review the affects, if any, that the Vidaza was having on the progression of Todd's MDS, this isn't the case. Instead, she wants to do a biopsy NOW to make sure that Todd's MDS isn't naturally progressing on its own since the last biopsy.
Todd was discouraged by this. He hadn't been flooding his body with the soy peptide or nutritional supplements he has been taking the last two years to help keep his body in optimal health. These products, purchased through the company Reliv, have had positive affects on keeping Todd's blast counts down (basically the cancer cells, which are immature and ineffective blood cells that can't function properly). Since he was experiencing nausea and lack of appetite, he had a hard time drinking them.
His doctor met in conference with the other bone marrow transplant doctors and the consensus was to do another round of Vidaza if his bone marrow results are "stable" which means about the same: 7-9% blast counts and no new chromosomal abnormalities. If the results show any more progression, there will not be another round of Vidaza. The bone marrow transplant will continue to be staged and scheduled as soon as possible.
The scheduling office called today and had an opening for this Friday morning for the bone marrow biopsy to be done in Cleveland. So Todd will be going this Friday instead of next week. Results will take several days, with preliminary results by Wednesday, May 28, or Thursday, May 29.
So, we wait.
Notes:
Defining a blast cell:
In a patient with a myelodysplastic syndrome, the blood stem cells (immature cells) do not become healthy red blood cells, white blood cells, or platelets. These immature blood cells, called blasts, do not work the way they should and either die in the bone marrow or soon after they go into the blood. This leaves less room for healthy white blood cells, red blood cells, and platelets to form in the bone marrow. When there are fewer healthy blood cells, infection, anemia, or easy bleeding may occur. (US Gov., web).For more information about MDS, blood cells, MDS, and to see a diagram of a bone marrow biopsy see: http://www.cancer.gov/cancertopics/pdq/treatment/myelodysplastic/Patient/page1
In assessing MDS, using the original IPSS scale (International Prognosis Scoring System), the doctors looked at blast cell counts in determining the risk assessment of the progression of the disease. When the blast cell count reaches 20% or more, it is then considered to be full Acute Myeloid Leukemia. Since diagnosis, Todd's counts have gone up and down from 2% up to 7% until reaching their highest point of 9% in the first few months of 2014. Now, the MDS community uses the IPSS-R (the Revised International Prognostic Scoring System) which takes more things into consideration, like hemoglobin, absolute neutrophil count, platelets, and cytogenetics and the number of chromosomal abnormalities, in addition to bone marrow blast cell counts.
Todd's doctors were using the 10% blast count as a personal threshold for doing the bone marrow transplant before he started developing chromosomal abnormalities a few months ago.
To learn more about the IPSS and the IPSS-R:
http://www.qxmd.com/calculate-online/hematology/myelodysplastic-syndrome-prognosis-ipss
http://www.mds-foundation.org/ipss-r-calculator/
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