Hello,
I will make the back story as brief as possible. In 2011 my husband was diagnoses with MM with kidney involvement requiring 5 years of dialysis. He received a Auto stem cell transplant and then proceeded to take Revlimid for the next 7 years, never reaching remission but stable disease. January of 2018 he was diagnosed with Therapy Related MDS delinquent 5q, 7q, 12p, a double mutated TP53, and complex abnormal karyotype in 20 out of 20 metaphases. We were told he would probably progress to AML fast and he had about 6 months. He was put on Vidaza, reduced dose because of recurrent lung infections and ESRD, 3 days out of every 5-6 weeks. He is being transfused for platelets at 10, and blood at 7, he receives a transfusion for platelets on average twice per week and once per week for blood. When Diagnosed with MDS- we were told he was not a candidate for another bone marrow due to lungs and kidneys. He was also not a candidate for "hard" chemo as they don't think he could survive. Fast forward to end of January 2019. His blast went from 5 to 29/42%?? in one month. BMB confirmed AMl. Only a couple of things have changed on the chromosone portion of the BMB, mainly -20,+2-3mar[cp20], this was there just changed a bit, otherwise everything is pretty much the same as pre AMl.
Thank you in advance for your help!

Couple of questions.

Question 1.
His Karyotype is as follow. Does anyone have info on any of these as it pertains to AML?


Karyotype
42-43,XY,-Y,ins(1;?)(p32;?),-2,-3,del(3)(q12),-4,-7,add(7)(p
11.2),add(7)(q11.2),der(11)t(11;19)(q13;q13.1),der (12)t(4;12
)(q21;p11.2),-16,-17,add(19)(p13.1)add(19)(q13.1),-20,+2-3ma
r[cp20]


Question 2
On the CD34 positive cells how can they be 40% in some places and 80/90% in others and what does this mean?

bone marrow biopsy, antibodies
to CD34, CD61, CD138, kappa and lambda immunoglobulin light
chains: CD34-positive cells are variably distributed; they
number approximately 40% overall, although in a few areas,
they constitute up to 80-90%

Question 3
Any thoughts on this as it pertains to AML? The only thing changed on this prior to AMl is the DC56.

Blasts: Increased
Express: CD34, CD45 (dim), CD13, CD33, CD117, HLA-DR, CD56
(partial), CD38 (partial).
Do not express: CD19, CD10, CD3, CD16, CD2, CD7, CD36,
CD64. Expression of CD15 appears equivocal to very dim.
Estimated size (by SSC/CD45): 42%

Question 4
Any thoughts on this as it pertains to AML. Curious about the hyposegmented. When I look it up it pulls up Pseudo Pelger-Hut anomaly. any thoughts on this?

The red blood cells show moderate
anisopoikilocytosis (increased elliptocytes). Dysplastic
hypogranular and rare hyposegmented neutrophils are
present. 29% circulating blasts