Hi @jalan00 It’s normal for all blood counts to drop during chemo treatments. Chemotherapy is intended to interfere with quickly dividing cells, such as cancer cells. (In this case, the 40% blast cells noted in your dad’s test results. Blasts can also be detected with a peripheral blood smear from a blood test. No need to wait for a BMB. )

There are other quickly dividing cells in the body, such as blood cells, hair follicles, finger/toe nails, mucosal lining of the digestive system. These can be collaterally damaged by the chemo therapy, along with the cancer cells. When the blood levels drop appreciably during chemo, as I mentioned in another reply, it can take time to build up stores again. The transfusions can help to keep your dad’s red cells and platelets in a comfortable zone. The Filgrastim promotes faster regeneration of the white blood cells to help your dad be less vulnerable to infections.

With 40% blasts, the goal is to knock those down as they have crowded out a 40% portion of healthy blood cells for your dad. As they die off and/or aren’t able to reproduce, that makes room for healthy blood cells again. But even though our bodies produce incredible amounts of blood cells daily, there can be some interruption in the efficiency of the bone marrow during chemo. So hang in there…you and your dad. Let the chemo work to get the leukemia under control. He’ll keep getting transfusions as needed during the next coming months. It’s normal to do that. I can’t even remember how many transfusions I had during my treatments. And just for reference, I had an 85% blast level when I was diagnosed with AML.

Though it’s frustrating, please try not to get discouraged with your dad’s progress. He’s only had 2 rounds of chemo thus far. These are reduced intensity drugs so it may not work as quickly but they are much better tolerated by older patients than aggressive chemo. As we age, our bodies aren’t able to process drugs as when we are younger. His doctor is using good judgment adjusting the meds in relation to your dad’s health and now feels it’s safe to give him the additional drug that is often used in tandem with Azacitidine.

Do you know if there’s been another peripheral blood smear to check for blasts?