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Mirror Images

Posted by Frederick Wasti
May 23 2012

Today was "just another typical Ofatumumab infusion day" at Dana-Farber. (Last week, Week 1 of Cycle 3, I had the "full Methylprednisone and Ofatumumab treatment".) Overall, things went relatively routinely.

The only time today when the situation was not as I was expecting (or hoping) was when I had my first look at the results from this morning's blood tests. I was hoping, of course, for a continued drop in the total white cell count, and that was the number I looked for first. However, I was immediately a bit disappointed to find that, rather than being below 10% (as it had been over the past two weeks), it had now gone up to 13.3%. (I did have a couple weeks of plateau a few weeks ago, but ~this~ was not just a plateau, but a distinct rise.) At that moment, telling myself that "well, the total white count can't keep marching to zero, and it maybe has to start leveling off sometime soon anyway" seemed to offer only a small consolation.

So here's the total lymphocyte graph, including data from just before the clinical trial started until today:

As you can see, there was a bit of an upturn over this past week, although admittedly it was not huge (even if somewhat unsettling).

However, after settling down and looking at some of the other numbers, I started to realize that there were some interestingly good numbers staring back at me. Please let me try to explain.

Perhaps you may remember wading through my "Blood Cells 101" entry (April 1st) and my "Fred Cells 101" and "Fred Cells 102" entries (April 3rd and 7th). (Or perhaps you were "lucky" enough to avoid them - <g>.) Well, you don't have to go looking back at them, because I'm going to provide you with the relevant numbers you need right here - <g>:

In normal blood, the percentage of the most common of the white blood cells, the neutrophils, is supposed to be about 60% or so, and the percentage of the next most common white cells, the lymphocytes, about 30% or so. However, back around the time of my CLL diagnosis, my neutrophil counts were down in the 10% to 15% range, and my mostly leukemic lymphocytes (which were responsible for crowding out the neutrophils) had counts up in the 70% to 80% range. The situation was, at that time, worse than upside down. Well, let's take a look at how the neutrophil and lymphocyte counts have changed since.

First, here's a graph of the lymphocyte percentage since the time of diagnosis:

And here is a graph of the neutrophil percentage over the same period of time:

I would like you to notice a few significant points:

1. At the time of diagnosis, the lymphocytes were much too high and the neutrophils were much too low.

2. During my "watchful waiting" period (from the time of diagnosis to the start of treatment), the situation did gradually get worse.

3. However, once treatment had started, the percentage of lymphocytes rapidly went down, while the percentage of neutrophils did rapidly increase.

4. Furthermore, the percentage of neutrophils is now ~almost~ as high as the percentage of lymphocytes (and, hopefully, that trend will continue until the neutrophils are significantly more numerous than the lymphocytes, as they should be).

5. Finally and interestingly (but not just coincidentally), the shape of the two curves form a pair of approximate mirror images. (That is to say that each curve looks like a corresponding vertical reflection of the other.) If you understand the significance of the two graphs, of course, you would recognize that this is the way it would have to be, as the two most numerous white cell types are competing for their share of the 100% that all the white cells have to add up to. And may the neutrophils be eventually restored to their proper prominence... :-)

Categories: Leukemia