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Work-Ups Done at M D Anderson

Cancer Center

From 5/94 through 2/96

This page and the others like it including the slides, pathology, and flow cytometry reports have been added to Grannybarb's story of my own volition and with the knowledge of all my hematologists/oncologists. I am working with Gerald Marti, M.D., NIH, who hopes, as I do, that they will provide additional insight for professionals and patients who may be interested in the technical part of CLL. For those who are simply reading the story, please feel free to skip this part.

These results were scanned into my computer. I've tried to make them correct, but cannot guarantee that they are 100% correct. The all caps format is used by M D Anderson and I haven't had the time to redo it all in lower case letters.

GrannyBarb

02/9/96 14:28 BARBARA B. LACKRITZ
Test Results: Lymphocytosis, Interstitial

2/8/96 TIME: 10:06 BY:Keating, Michael,M.
DIAGNOSIS: BM consistent with chronic lymphocytic leukemia
increased prolymphocytes is noted.
COMMENTS : Touch imprint shows higher number of lymphoid cells.

. Electronically Signed by Mahrer Albitar, M.D. 2/12/96

** HIST, REQ: THUR 2/8/96 TIME: 10:49 BY:Keating; Michael M. M.D.

TEST NAME RESULTS UNITS NORMAL RANGE 3499.Sig Lambda 27.1 % (4.5- 14.1) 3495.Sig (+) : 16.8 % (1.30- 29.90) 1738 Sig M+D Intensity 1+ N/E 34 98 Sig Kappa -5.9 % (7.10- 18.103)

MARKERS ON: Lymphocytes :
INTERPRETATION: Consistent with B Cell CLL

Electronically Signed Yang O. Huh, M. D . 2/9/96

HIST, REQ: 2/8/96 BY:Keating, Michael, M.

TEST NAME                                           RESULTS UNITS                               NORMAL RANGE
1638 FMC-7, BM . .                                4.4 %                               N/E
1793 ACTIVAT. B CELL CD23:            89.0 %
1644. FMC-7, PB                                    6.7 %                               N/E
1792 ACTIVAT. B CELL CD23             83.5 %
1618 Lymphoma Panel (PB)                                                See Individual Marker

Electronically Signed Yang O. Huh, M. D . 2/9/96

PATIENT: Lackritz Barbara B.   Sex/Race: W,F
*** HIST, REQ: 2/8/96    by: Keating, Michael, M.

TEST NAME: RESULTS UNITS NORMAL RANGE 1658.EARLY B CELL CD19 82.8 % (1.10-18.70) 1007.T CELL ANTIGEN CD3 11.2 % (60.5- 89.3) 1008.HELPER T CD4 6.4 % (25.8- 61.8) l009.SUPRESSOR T CD8 6.1 % (13.4- 47.0) 1606.PAN T/B CLL(L-1) CD5 96.9 % (62.9 - 87.3) 1014.SIG (M+D) 22.9 % ( 0.1 - 14.3) 1734.SIG M+D INTENSITY 1+ N/E 1015.SIG KAPPA 5.5 % (7.2 - 13.8) 1607.SIG LAMBDA 30.2 % (5.0 - 12.0) 468 CDl9+CD5+ (PB) 82.6 %

MARKERS ON: Lymphocytes
INTERPRETATION: Consistent with B Cell CLL

Electronically Signed Yang O. Huh, M. D . 2/9/96

PATIENT: Lackritz, Barbara B SEX/RACE:FW
** HIST, REQ:2/8/96 by:Keating, Michael, M.

DIAGNOSIS: Bone marrow biopsy:
Small lymphocytic leukemia/lymphoma in bone marrow

COMMENT: Sections show a fragmented and somewhat distorted bone marrow core biopsy. Cellularity is about 20%. There is an interstitial infiltration of small Lymphocytes which constitute about 50% of the cellular elements present in the core biopsy. These findings are consistent with small lymphocytic lymphoma/leukemia.

Gross Description: Bone marrow biopsy - A 1.1 cm. core biopsy of bone, submitted entirely .

Pathologist: T. J. McDonnell, M.D. FINAL DATE:02/09/96 Consultant: Keating, Michel, M., M.D.

** HIST, REQ: 2/8/96 by:Keating, Michael, M., M.D.

TEST NAME RESULTS UNITS NORMAL RANGE 1658.EARLY B CELL CD19 82.8 % (1.lO-18.70) 1007.T CELL ANTIGE CD3 11.2 % (60.5 -89.3) 1008.HELPER T CD4 6.4 % (25.8- 61.8) 1009 SUPPRESSOR T CD8 6.1 % (13.4- 47.0) 1606.PAN T/B CLL(L-1)CD5 96.9 % (62.9- 87.3) 1014.SIG (M+D) 22.9 % (0.1- 14.3) 1736.SIG M+D INTENSITY l + N/E 1015.SIG KAPPA 5.5 % (7.2 - 13.8) 607.SIG LAMBDA 30.2 % (5.0 - 12.0) 468 CDl9+CD5+ (PB) 82.6 %

Markers on: Lymphocytes
INTERPRETATION consistent with B Cell CLL

Electronically Signed Yang O. Huh, M. D . 2/9/96

2/8/96 by:Keating, Michael,M. MD

TEST NAME RESULTS UNITS NORMAL RANGE 2997 GAMMA A (NEPH) 23 L MG/100ML (74.0- 327.0) 2998 GAMMA M (NEPH) 24 L MG/100ML (29.0- 214.0 ) COMMENT: NOTE: NEW REFERENCE RANGES 300 HEMATOLOGY SURVEY 324 WBC COUNT 14.9 K/UL (4.0 - 11.0) 321 RED BLOOD CELL COUNT 4.83 M/UL F(4.0 - 5.5) M(4.5 - 6.0) 365 HEMOGLOBIN 14.0 G/DL F(12.0 -16.0) M(14.0-18.0) 360 HEMATOCRIT 41.2 % F(37.0 -47.0) M(40.0-54.0) 304 MCV 85 FL (82.0 --98.0) 306 MCH 29.0 PG (27.0 -31.0) 307 MCHC 34.0 G/DL (31.0 -36.0) 371 RDW 15.0 % (12.0 -15.5) 325 DIFFERENTIAL MANUAL 100 COMMENT ( 25) PLATELETS ADEQUATE 1161.NEUT 31 % (42.0 - 66.0) 311.LYMPH 69 % (24.0 - 44.0) 1910.NEUT ABS 4.6 % (01.7 -- 7.3) 1911.LYMPH ABS 10.3 K/UL (01.0 - 4.8) 327.PLATELET COUNT 193 K/UL (140.0-440.0) 274.MPV 9.1 FL (4.0 - 10.4) 1191.IG KAPPA DNA PROBE; POST CALL MOLECULAR DIAGNOSTICS

COMMENT: (3313) By Southern Blot Analysis 2334 ECOR I GERMLINE 2336 HIND III GERMLINE

There were no definite rearranged bands detected with a probe for the Ig Kappa light chain gene. Correlation with the immunophenotype is suggested.

PATIENT: Lackritz Barbara B. SEX/RACE:F,W
2/17/95 BY:Khouri, Issa, F., M.D.

IMMUNOLOGY REPORT-SPECIMIN PERIPHERAL BLOOD

TEST NAME RESULTS UNITS NORMAL RANGE lYMPHOMA PANEL (PB) SEE INDIVIDUAL MARKER 1640 NK AG. (L-19) CD56 23.3 % (00.10-22.30) 1658 EARLY B CELL CD19 42.8 % (01.10-18.70) 1007 T CELL ANTIGEN CD3 29.4 % (60.5 -89.3 ) 1008 HELPER T CD4 29.0 % (25.8 -61.8 ) 1009 SUPRESSOR T CD8 13.2 % (13.4 -47.0 ) 1606 PAN T/B CELL (L-1) CD5 53.7 % (62.9 -87.3 ) 1014 SIG (M+D) 41.6 % (00.1 -14.3 ) SIG M+D INTENSITY 2+ N/E 1015 SIG KAPPA 24.5 % (07.2 -13.8 ) 1607 SIG LAMBDA 13.6 % (05.0 -12.0 ) CD19+CD5+(PB) 23.4 %

Electronically Signed Yang O. Huh, M. D . 2/17/96

TEST NAME RESULTS UNITS NORMAL RANGE lYMPHOMA PANEL (P8) SEE INDIVIDUAL MARKER 1640 NK AG. (L-19) CD56 23.3 % (00.10-22.30) 1658 EARLY B CELL CD19 42.8 % (01.10-18.70) 1007 T CELL ANTIGEN CD3 29.4 % (60.5 -89.3 ) 1008 HELPER T CD4 29.0 % (25.8 -61.8 ) 1009 SUPRESSOR T CD8 13.2 % (13.4 -47.0 ) 1606 PAN T/B CELL (L-1) CD5 53.7 % (62.9 -87.3 ) 1014 SIG (M+D) 41.6 % (00.1 -14.3 ) SIG M+D INTENSITY 2+ N/E 1015 SIG KAPPA 24.5 % (07.2 -13.8 ) 1607 SIG LAMBDA 13.6 % (05.0 -12.0 ) CD19+CD5+(P8) 23.4 %

Electronically Signed Yang O. Huh, M. D . 2/17/96

TEST NAME RESULTS UNITS NORMAL RANGE lYMPHOMA PANEL (PB) SEE INDIVIDUAL MARKER 1640 NK AG. (L-19) CD56 23.3 % (00.10-22.30) 1658 EARLY B CELL CD19 42.8 % (01.10-18.70) 1007 T CELL ANTIGEN CD3 29.4 % (60.5 -89.3 ) 1008 HELPER T CD4 29.0 % (25.8 -61.8 ) 1009 SUPRESSOR T CD8 13.2 % (13.4 -47.0 ) 1606 PAN T/B CELL (L-1) CD5 53.7 % (62.9 -87.3 ) 1014 SIG (M+D) 41.6 % (00.1 -14.3 ) SIG M+D INTENSITY 2+ N/E 1015 SIG KAPPA 24.5 % (07.2 -13.8 ) 1607 SIG LAMBDA 13.6 % (05.0 -12.0 ) CD19+CD5+(PB) 23.4 %

Electronically Signed Yang O. Huh, M. D . 2/17/96

PATIENT: Lackritz Barbara B. SEX/RACE:F,W
3/29/95 BY:Champlin, Richard, E., M.D.

1190 IG HEAVY CHAIN J POST PURGE CALL MOLECULAR DIAGNOSTICS LAB COMMENT: (3313) BY Southern Blot Analysis 2334 ECOR I GERMLINE 2330 HIND III GERMLINE
There were no definite rearranged bands detected with a probe for the JH region of the innumoglobulin heavy chain gene. Correlation with the immunophonotype is suggested.

1191 IG KAPPA DNA PROBE PRE PURGE CALL MOLLECULAR DIAGNOSTICS LAB COMMENT: BY SOUTHERN BLOT ANALYSIS 1381 MDL I.D. NUMBER: 12435 2334 ECOR I REARRANGE 2330 HIND III REARRANGE The presence of rearranged bands with the Ig KAPPA chain probe is consistent with B-Cell lineage commitment. The faint rearranged bands are identical to the bands seen in a previous sample: #10845 from 5/23/94 Correlation with the immunophenotype is suggested. PATHOLOGIST: Cheryl Hirsch Ginsberg, M.D. REPORTED 3/29/95

PATIENT: Lackritz Barbara B. SEX/RACE:F,W
2/24/95 BY:Champlin, Richard, E., M.D.

TEST NAME RESULTS UNITS NORMAL RANGE PAN B CD20 1.4 % (3.20 -19.60) 1658 EARLY B CELL CD19 0.5 % (01.10-18.70) 1606 PAN T/B CELL (L-1) CD5 61.6 % (62.9 -87.3 ) 1015 SIG KAPPA 1.0 % (07.2 -13.8 ) 1607 SIG LAMBDA 0.2 % (05.0 -12.0 ) MARKERS ON: LYMPHOCYTES INTERPRETATION:PRE B CELLS DETECTED. ANALYZED REGION IS 33%. POST PURGE. 1666 PROGENITOR Ag CD34 1.8 % CD33+CD34+(PB) N/A 1976 CD34+CD19+CELLS 0.1 % N/E CD19 STEM CELLS (PB) 0.5 % NONE ESTABLISHED MARKERS ON: MONONUCLEAR CELLS Small number of cells show reactivity with CD34 Cell count is 1.8K/UL. Analyzed region is 39%. Absolute cd34+ cells is 13/UL

Pathologist: Yang 0. Huh, M.D. Reported 2/27/95

TEST NAME                                         RESULTS UNITS                                      NORMAL RANGE

1666 PROGENITOR Ag       CD34       1.0 %

CD33+CD34+(PB)                                N/A

1976 CD34+CD19+CELLS                    0.2 %                                               N/E

CD19 STEM CELLS            (PB)         39.5 %                                     NONE ESTABLISHED MARKERS ON: MONONUCLEAR CELLS   Small number of cells show reactivity with CD34. Cell count is 2.4K/UL. Analyzed region is 45%. Absolute cd34+ cells is 11/UL.

Pathologist: Yang 0. Huh, M.D. Reported 2/27/95

2/27/95 BY:Champlin, Richard, E., M.D.

TEST NAME RESULTS UNITS NORMAL RANGE PAN B CD20 32.8 % (3.20 -19.60) 1658 EARLY B CELL CD19 33.7 % (01.10-18.70) 1606 PAN T/B CELL (L-1) CD5 57.0 % (62.9 -87.3 ) 1015 SIG KAPPA 14.2 % (07.2 -13.8 ) 1607 SIG LAMBDA 13.6 % (05.0 -12.0 ) CD19+CD5+(PB) 7.6 % Markers On: Lymphocytes Interpretation: Suggestive of abnormal B Cell phenotype with no apparent light chain restriction. Analyzed region is 33%. Suggest molecular study. Pre purge. 1666 PROGENITOR Ag CD34 1.6 % CD33+CD34+(PB) N/A 1976 CD34+CD19+CELLS 0.0 % N/E CD19 STEM CELLS (PB) 32.2 % NONE ESTABLISHED Small number of cells show reactivity with CD34 Cell count is 3.1K/UL. Analyzed region is 45%. Absolute cd34+ cells is 22/UL

Pathologist: Yang 0. Huh, M.D. Reported 2/17/95

HIST, REQ:2/13/95 by:Khouri, Issa, F. M.D.

TEST NAME RESULTS UNITS NORMAL RANGE 90.HEP B SUP ANTIGEN : NON-REAC 62.HEP B CORE-AB : NON-REAC 48.HEP C VIRUS AB 2.0 : NON-REAC 1241.ALT : NON-REAC IU/L <106 590.RPR SCREEN : NON-REAC 1676.HIV-1/2 : NON-REAC 13.HTLV-I AB : NON-REAC 58.CMV-AB-LA : NON-REAC

Serologic Screening for transfusion transmitted diseases
is unremarkable, for this patient, atthis time.

Pathologist: Benjamin Lichtiger, M.D.,Ph.D

HIST, REQ: 2/13/95. BY Khouri, Issa, F, M.D>

TEST NAME RESULTS UNITS NORMAL RANGE 1652.LYMPHOMA PANEL [BM) % SEE INDIVIDUAL MARKER 3517.BM CD56+CD3 (-)-) 30.7 % (0.9-- 14.9)

Pathologist: Benjamin Lichtiger, M.D.,Ph.D

PATHOLOGY/CYTOLOGY RESULTS

Lackritz, Barbara B. Gender: F,W Recd: 2-08-96
Pathologist: T. J. McDonnell, M.D. Final Date:02/09/96
CONSULTANT: Keating, Michael, M.D.

D:N DIAGNOSIS : Bone marrow biopsy
small lymphocytic lymphoma/leukemia in bone marrow

COMMENT: Sections show a fragmented and somewhat distorted bone marrow core biopsy. The cellularity is about 20%. There is an interstitia1 infiltrate of small lymphocytes with constitute
about 50% of the cellular elements present in the core biopsy.
These findings are consistent with small lymphocytcic lymphoma/leukemia.
TM/ 9-Feb-96

RECD: 2/13/95 CONSULTANT: Khouri, Issa, F, M.D.

2099: Bone Marrow Smear:
Dilute with peripheral blood
Rare Atypical Lymphoid Cells

2289 CELLULARITY, BM-BX 40% 2199 BM-BIOPSY MEGAKARYOCYTES: ADEQUATE NUMBER LYMPHOID AGGREGATES 2098 BM-CLOT CLOT SECTION: INADEQUATE NO PARTICLES

2200 DIAGNOSIS, BM
Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma involving bone marrow. COMMENT: Approximately 55% of the cellular bone marrow is involved.

LEFT SIDE

335.BONE MARROW 200.0 % 727.BLAST,BM 0.5 %                TECH POOR QUALITY 759.LEUKEMIC CELL, BM 0 %                NO PARTICLES PRESENT 728.PROGRANULOCYTE, BM 1.5 % 751.MYELOCYTE, BM 19.0 % 706.SEG NEUTROPHIL, BM 54.5 % 708.ESINOPHIL,BM 0.5 % 709.BASINOPHIL, BM 0.5 % 704.LYMPHOCYTE, BM 8.5 % 702.MONOCYTE, BM 1.5 % 769.NORMOBLAST, BM 8.5 % 2288.ME/RATIO, BM-BX 9.5

RIGHT SIDE

727.BLAST,BM 0.0 %                 TECH POOR QUALITY 759.LEUKEMIC CELL, BM 0.0 %                 NO PARTICLES PRESENT 728.PROGRANULOCYTE, BM 1.0 % 751.METAMYELOCYTE, BM 10.0 % 706.SEG NEUTROPHIL, BM 75.0 % 708.ESINOPHIL,BM 0.5 % 704.LYMPHOCYTE, BM 6.5 % 702.MONOCYTE, BM 4.5 % 769.NORMOBLAST, BM 2.5 % 2288.ME/RATIO, BM-BX 34.6 393.ACID PHOS STAIN NEG 1691.TRAP NEG 2436 BM-SPECIAL STAINS RETICULIN 1+ COLLAGEN (TRICHROME STAIN) 1+

2099: Bone marrow smear:
SMEAR:contaminated with peripheral blood
rare atypical lymphoic cells

2289 CELLULARITY, BM-BX 50% 2199 BM-BIOPSY MEGAKARYOCYTES: ADEQUATE NUMBER LYMPHOCYTOSIS, INTERSTITIAL AND NODULAR 2098 BM-CLOT CLOT SECTION: INADEQUATE

2200 DIAGNOSIS, BM --RIGHT SIDE
Chronic lymphocytic leukemia/small lymphocytic lymphoma involving bone marrow. COMMENT: Approximately 40% of the cellular bone marrow is involved. RIGHT SIDE

2099: Bone marrow smear:
SMEAR: dilute with peripheral blood
rare atypical lymphoid cells

2289 CELLULARITY, BM-BX 40% 2199 BM-BIOPSY MEGAKARYOCYTES: ADEQUATE NUMBER LYMPHOID AGGREGATES 2098 BM-CLOT CLOT SECTION: INADEQUATE NO PARTICLES

2200 DIAGNOSIS, BM --LEFT SIDE
Chronic lymphocytic leukemia/small lymphocytic lymphoma involving bone marrow. COMMENT: Approximately 55% of the cellular bone marrow is involved. RIGHT SIDE

2099: Bone marrow smear:
SMEAR: dilute with peripheral blood
rare atypical lymphoid cells

RECD: 5-24-94 Pathologist John T. Manning, M.D. FINAL DATE:05/25/94
CONSULTANT: Keating , Michael, M.D.

D:N DIAGNOSIS: Bone marrow biopsy:
small lymphocytic lymphoma/leukemia in bone marrow

COMMENT: Bone marrow cellularity averages 75%. Greater than 80% of bone marrow cells are lymphocytes. The histologic pattern is variable In some areas the pattern is mixed nodular and inter-
stitial but in at least. 1/3 of the marrow the histologic pattern is diffuse.
25-May-94

LACKRITZ, BARBARA, B RECEIVED: 11-14-94   DX COMPLETED 11-15-94
PATHOLOGIST: John T. Manning, M.D.   TO: Keating, Michael M. D .

D:N DIAGNOSIS: B0NE MARROW BIOPSY
Bone marrow, no diagnostic evidence of small lymphocytic lymphoma/leukemia.

COMMENT: cellularity of this bone marrow sample is highly variable.
One half of the biopsy is cellular bone marrow averaging 25% cellularity, and the other half is acellular bone marrow.
JTM

PATHOLOGIST: John T. Manning
RECD: 5-24-94 CONSULTANT: Keating, Michael M., M.D. FINAL DATE: 05/24/94 DX Completed 05-23-94

D:N DIAGNOSIS : BONE MARROW BIOPSY

small lymphocytic lymphoma/leukemia in bone marrow.
COMMENT: Bone marrow cellularity averages 75%. Greater than 80% of bone marrow cells are lymphocytes. The histologic pattern is variable. In some areas the pattern is mixed nodular and interstitial but in at least 1/3 of the marrow the histologic pattern is diffuse
JTM 25-May-94

RECD: 5-23-94 Pathologist:William C. Pugh, M.D
FINAL DATE: 05/24/94 DX COMPLETED 05-23-94

TO: ST . Luke's Hospital
Chesterfield, Missouri. 63017

DIAGNOSIS:

Ten slides (S89-11912), designated bone marrow biopsy (DATED 8/17/89)
Small Lymphocytic Lymphoma/ Leukemia involving bone marrow.
Lymphocytosis consistent with Chronic Lymphocytic Leukemia, peripheral blood smear.
COMMENT: Uninvolved portions of the core biopsy average about 65% cellular Nodular and interstitial infiltrates of small lymphoid cells constitute perhaps 75% of cellular elements. Possible plasmacytoid differentiation is suggested.
23-May-94 WCP

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You're reading GrannyBarb's CLL Story - Page 4

page one - Diagnosis
page two - Treatment
page three - Bone Marrow Transplant

Bloodwork for the Diagnosis Section of the Story
Bloodwork for the Treatment Section of the Story
Bloodwork for My Stay in the BMT unit
Pathology Workups from St. John's Mercy Medical Center 1996-97
Pathology Workups from M D Anderson through Feb, 1996
Early Biopsy Slides - SJMMC, MDACC
Pathology for the 6 month Post-BMT Check-Up, Dana Farber Cancer Institute

Other Leukemia Survivors' Stories

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