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What Does This Flow Cytometry Report Indicate?
Question: ATTN DR INDRANIL GOSH
THIS DISCUSSION IS FLOW UP OF MY MOTHER DISCUSSION MRS XXXXXXX XXXXXXX (NON HODKIN LYMPHOMA PATIEM ON REMMISION FROM 2012)
DEAR SIR I WANT TO DESCUSS FURTHER ABOUT MY MOTHER .AS ADVICED BY YOU WE DID FLOW CYMETORY TEST WHICH IS NOY SOUNDING WELL(REPORT OF FLOW CYMETORY ATTACHED )AFTER THAT ONE OF CONCERNED DOCTOR ADVICED ME To DO PET CT AFTER SEEING FLOW CYTEMOTARY AND WE DID PET CT TOO BUT PET CT IS OK NO EVEDIENCE IF ANY DEASES IS NOTED.AND AGAIN HE ADVICE ME TO DO COOMBS TEST TO BE DONE DIRECT AND INDERCT TEST WE DID TOO AND ITS REPORT IS ALSO NEGATIVE .
KINDLY ADIVE FURTHER AND HELP US TOO DIOGONSE FURTHER.REPORR ATTACHED ý
THIS DISCUSSION IS FLOW UP OF MY MOTHER DISCUSSION MRS XXXXXXX XXXXXXX (NON HODKIN LYMPHOMA PATIEM ON REMMISION FROM 2012)
DEAR SIR I WANT TO DESCUSS FURTHER ABOUT MY MOTHER .AS ADVICED BY YOU WE DID FLOW CYMETORY TEST WHICH IS NOY SOUNDING WELL(REPORT OF FLOW CYMETORY ATTACHED )AFTER THAT ONE OF CONCERNED DOCTOR ADVICED ME To DO PET CT AFTER SEEING FLOW CYTEMOTARY AND WE DID PET CT TOO BUT PET CT IS OK NO EVEDIENCE IF ANY DEASES IS NOTED.AND AGAIN HE ADVICE ME TO DO COOMBS TEST TO BE DONE DIRECT AND INDERCT TEST WE DID TOO AND ITS REPORT IS ALSO NEGATIVE .
KINDLY ADIVE FURTHER AND HELP US TOO DIOGONSE FURTHER.REPORR ATTACHED ý
Brief Answer:
Appears to be marginal zone lymphoma
Detailed Answer:
Hi
Thanks for followup.
The current report of flow cytometry suggests marginal zone lymphoma. As blood is involved, that implies bone marrow is involved, even though PET-CT is normal. As hemoglobin is quite low but Coomb's test is negative, it suggests that bone marrow is not efficiently producing red blood cells. This should be confirmed by a bone marrow biopsy.
In that case, it needs treatment (low hemoglobin is an indication for treatment). I usually treat these patients with rituximab with bendamustine combination. Results are quite good in terms of disease control but being a low grade lymphoma, it is incurable and relapses are the rule.
Hope this helps.
Regards
Appears to be marginal zone lymphoma
Detailed Answer:
Hi
Thanks for followup.
The current report of flow cytometry suggests marginal zone lymphoma. As blood is involved, that implies bone marrow is involved, even though PET-CT is normal. As hemoglobin is quite low but Coomb's test is negative, it suggests that bone marrow is not efficiently producing red blood cells. This should be confirmed by a bone marrow biopsy.
In that case, it needs treatment (low hemoglobin is an indication for treatment). I usually treat these patients with rituximab with bendamustine combination. Results are quite good in terms of disease control but being a low grade lymphoma, it is incurable and relapses are the rule.
Hope this helps.
Regards
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
dear sir as i already told you itaken advice from local doctor.he advice me to wait now and do blood test on montjly basis .he says if homglobin is 7000 or low or plattes count is 50000 and more or any lymphnode is not there then we will wait and observe
kindly advice we are really very woried
kindly advice we are really very woried
Brief Answer:
Hemoglobin below 11 is considered significant
Detailed Answer:
Sometimes if previous hemoglobin was low we can wait till 10 but 9.2 is quite low. Hence I am in favor of treatment. But the doctor actually treating her should be the best person to judge.
If you are in XXXXXXX you can take second opinion from Dr XXXXXXX Singhal at Apollo XXXXXXX
Hemoglobin below 11 is considered significant
Detailed Answer:
Sometimes if previous hemoglobin was low we can wait till 10 but 9.2 is quite low. Hence I am in favor of treatment. But the doctor actually treating her should be the best person to judge.
If you are in XXXXXXX you can take second opinion from Dr XXXXXXX Singhal at Apollo XXXXXXX
Above answer was peer-reviewed by :
Dr. Nagamani Ng
as per Dr XXXXXXX natra if there is no fever,no weight loss sign,no lymphnode ,ldh is in range and TLc is 14000 and on 01aug when we did flowcytemotery then homogolbin is 9.7 and according to.him if homoglobin is above 7000 and then no treatment is required till we are not vetting any above symptoms.
second het spleen is removed in 2003 due to enlarged spleem and then alao we did biopsy of spleen we are not gettinv any evedince at that fime and suddenly in 2010 she diaognosed with b grade NHL LARGE CELL .ADVANCE STAGE and treated with RCHOP 8 CYCLES.and from then till now no any such major complaint we noticed except her L5 comprasioom in 2011 FOR THT she is not able to sit properly and off and on itching in her body (in yeses days its more frequent)
and her homoglobin is never above 11.3 and in 2013 also one report i send previously in which her lympocytes are around 7000 and tlc is 13000 and homoglobin is around 11
as per your previous email too its written early treatment is not benficery if we are not getting any symptom
Doctor i understand this is my conern towards my loved ones
kindly guide me what exacly we shoud do and if we treated early what harm.we face or vice versa
thanks
second het spleen is removed in 2003 due to enlarged spleem and then alao we did biopsy of spleen we are not gettinv any evedince at that fime and suddenly in 2010 she diaognosed with b grade NHL LARGE CELL .ADVANCE STAGE and treated with RCHOP 8 CYCLES.and from then till now no any such major complaint we noticed except her L5 comprasioom in 2011 FOR THT she is not able to sit properly and off and on itching in her body (in yeses days its more frequent)
and her homoglobin is never above 11.3 and in 2013 also one report i send previously in which her lympocytes are around 7000 and tlc is 13000 and homoglobin is around 11
as per your previous email too its written early treatment is not benficery if we are not getting any symptom
Doctor i understand this is my conern towards my loved ones
kindly guide me what exacly we shoud do and if we treated early what harm.we face or vice versa
thanks
Brief Answer:
Yes early treatment is not beneficial
Detailed Answer:
I fully remember what I said in last conversation. But I had overlooked the hemoglobin report of 9.2 gm/dl. But I remember mentioning that low hemoglobin is an indication of treatment.
It is important to follow the treating doctor's opinion and if he feels that it can be observed and when hemoglobin falls to 7 gm/dl (it can't be 7000) then he can start the treatment then surely you can do that.
I can give you a general guideline but never what actually should be done in her. That can only be decided by the treating doctor.
Yes early treatment is not beneficial
Detailed Answer:
I fully remember what I said in last conversation. But I had overlooked the hemoglobin report of 9.2 gm/dl. But I remember mentioning that low hemoglobin is an indication of treatment.
It is important to follow the treating doctor's opinion and if he feels that it can be observed and when hemoglobin falls to 7 gm/dl (it can't be 7000) then he can start the treatment then surely you can do that.
I can give you a general guideline but never what actually should be done in her. That can only be decided by the treating doctor.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
dr i am really greatfull for yoir early reply but your opiniom matter to us for taking decission.second we are corelating now 2003 surgery of removing spleen is realted with that deases and its diverse in non hodkin b grade large cell lymphoma in 2010 and treatment till 2011 its in remission till now and again it come with mzl .is it all corealted?
secind in the abseanse of spleen is any more harm wuth that?
secind in the abseanse of spleen is any more harm wuth that?
Brief Answer:
It seems everything is related to marginal zone lymphoma
Detailed Answer:
marginal zone lymphoma can start in spleen, maybe it was missed. Then it recurred in the lymph nodes. Sometimes it is difficult to distinguish between marginal zone lymphoma and DLBCL on small biopsies. Then treated for DLBCL which works fine for marginal zone lymphoma also. So it was controlled for all these years.
Now it has recurred. So the question is whether to treat now or wait. As I said, I would treat with a hemoglobin of 9.2, provided bone marrow shows excess lymphoma cells are suppressing normal red cell precursors. But individual opinion may vary regarding exactly when to start.
It seems everything is related to marginal zone lymphoma
Detailed Answer:
marginal zone lymphoma can start in spleen, maybe it was missed. Then it recurred in the lymph nodes. Sometimes it is difficult to distinguish between marginal zone lymphoma and DLBCL on small biopsies. Then treated for DLBCL which works fine for marginal zone lymphoma also. So it was controlled for all these years.
Now it has recurred. So the question is whether to treat now or wait. As I said, I would treat with a hemoglobin of 9.2, provided bone marrow shows excess lymphoma cells are suppressing normal red cell precursors. But individual opinion may vary regarding exactly when to start.
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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