Can anyone figure out my MRD

[johnliston]

Can anyone figure out what my MRD ( CLL cells per 10,000) is from this report.

Component Your Value Standard Range

Interpretation

Flow cytometric immunophenotyping performed on the peripheral blood shows a small, dim kappa restricted B-cell population (representing ~98% of B cells, 6% of total lymphocytes and <1% of total cellular events) that is CD19+, CD5+, CD20-, CD81-, CD43+, and CD79b-, consistent with residual chronic lymphocytic leukemia (CLL).

Comment: Based on the patient's current absolute lymphocyte count of 0.7 k/uL, the absolute monotypic B-cell count is estimated to be 0.04 k/UL.

Clinical Information

The patient is a 70-year-old male with history of CLL diagnosed in 2002. Most recent flow cytometric immunophenotyping from 9/7/2022 shows a monotypic kappa light chain-restricted B-cell population that is CD19+, CD5+, dim CD20, CD43+, CD81-, and CD79b- (NML22-1380). CBC from 3/9/2023 shows an absolute lymphocyte count of 0.7 k/uL.

Specimen/Gross Description

Peripheral Blood (6 cc)

Flow Cytometry Immunophenotyping Results

Cell Populations:

Lymphocytes 7%, Monocytes 2%, Granulocytes 90%

Lymphocyte Subsets:

CD19+ B-cells 6%, CD19+Kappa+ 97%, CD19+Lambda+ <1%

CD3+ T-cells 87%

Total events collected: 1,263,504

Antibody Panels Tested:

Kappa/Lambda/CD79b/CD20/CD5/CD3/CD81/CD19/CD45/CD43

My WBC was 7.4 10ˆ3/µL

Thanks john

[AussieNeil Partner Administrator]

Hi John,

A year ago you shared that you were no longer uMRD 18 months after your 2 year trial and I needed to look at your post history to see that you've recently been having rituximab infusions to treat your AIHA. This is where populating your bio really helps respondents help you healthunlocked.com/profile/... When do you next see your specialist?

With respect to what you have shared, given your stated "absolute monotypic B-cell count is estimated to be 0.04 k/UL", and your "WBC was 7.4 10ˆ3/µL", you have a very good MRD result of 0.04/7,400 or 1 in 185,000, which puts you at better than uMRD5, but I don't think you can do this kind of calculation. The MRD report usually states how many monoclonal B cells have been found in how many white blood cells, which is your MRD result. Irrespective, you've achieved a very low level of CLL

How is your haemoglobin count now?

Neil

[johnliston in reply to AussieNeil]

Neil, Thanks for your answer. I really didn't know if this made sense either.

I had this done for my Dr. at M D Anderson, who ran the trial I was in, but I had it done locally at Northwestern and the way they interpreted is different from MDA so it's hard to compare.

Anyway since I just had 7 rounds of Rituxan at the time of this test it's hard to know what it means.

My last Hemoglobin was 13.4 up from 8.3 when I first started prednisone and Rituxan. But what they were concerned about was the Haptoglobins which initially came back , but disappeared again when they cut back on steroids. They increased the steroid again and the haptoglobins are coming back and they are going to take more time to reduce the steroids this time.

Thanks again for your reply and I'll work on my profile

john

[AussieNeil Partner Administrator in reply to johnliston]

Thanks for the background info John, you must be feeling much better with that nice improvement in your anaemia! Good to know that your medical team have worked out how to keep those haptoglobulins under control. I hope you are tolerating the steroids okay.

Thanks also in advance for populating your bio. Not only does it make it easier for those responding to give you more specific answers to your questions, it helps others who are going through a similar experience to know what questions to ask of their medical team and what to expect.

It must have been worrying, going through that AIHA experience, particularly when the haptoglobulins came back, but achieving that deep CLL remission is a nice bonus. You'll have the rituxan circulating in your blood for a year or so after your last infusion, picking off any more CLL cells that make an appearance too. Downside is that you aren't going to make any new antibodies during that time, so vaccine boosters are only going to awaken any memory B cells and boost your T cells.

Neil