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And May Their Paths Never Cross Again

Posted by Frederick Wasti
May 30 2012

Today was "just another ol' Ofatumumab day at Dana-Farber". Things went pretty smoothly, except: Because of the Memorial Day weekend (and the larger than usual number of patients being serviced today), the wait to get an intravenous line started and to have my blood drawn was longer than usual, and therefore the time my blood test results came back, so that Dr. Fisher could check them and provide the orders for the day, was later than usual. So, we probably ended up spending an hour and a half longer at D-F than we did last week. Oh well...

The good news is that the blood test results showed even more improvement - that is to say my lymphocytes continued to decline, so that the proportion of lymphocytes compared to neutrophils could continue to improve. Let's go to the graphs:

Here is the latest graph showing my lymphocyte proportion of the total white cell count:

And here is the corresponding graph for the neutrophil proportion:

Last week's "mirror image" situation continues, with a milestone of sorts having been reached sometime during this past week. On the previous Wednesday, the lymphocytes had dropped to 48% while the neutrophils had risen to 45%. However, today, the lymphocytes have fallen to 35% and the neutrophils have risen to 56%. This milestone would have been reached at the exact moment, sometime during the past week, when the neutrophils actually surpassed the lymphocytes for the first time in several years. (Don't forget that, in normal blood, neutrophils ~should~ be approximately twice as numerous as lymphocytes, yet, in my blood, lymphocytes have been far more numerous for quite some time now, since well before diagnosis.)

Despite the mirror images that the above two graphs form, though, the changes in proportion over time have mostly been due to the large increase in ~lymphocytes~ over a number of years, followed by a recent rapid decline due to treatment.

Let's look at the absolute number of lymphocytes (in thousands of cells per microliter) since diagnosis:

Now let's compare the absolute number of neutrophils over the same time period:

The lymphocyte numbers can be seen to have changed quite dramatically, while, at first glance, the trends in the neutrophil count may seem a bit less obvious.

The lymphocytes had been on a fairly steady march upward from diagnosis to treatment, and then (quite fortunately) went into a rapid decline. In contrast, the neutrophils, several years ago (before CLL started to rear its ugly head), certainly must have been the most numerous of my white blood cell types, but, due to leukemic lymphocytes crowding them out, they did decline over time until treatment started (and, in fact, they had declined so much by this past February, that the low neutrophil count was a major factor pointing to the need for treatment).

Still, if one looks carefully at the absolute neutrophil graph, it does show that the neutrophils have indeed bounced back once treatment began, even if the graph appears to be a bit on the "jagged" side. However, as I see it, the neutrophils may simply be coming along just as fast as they can, considering that they may be doing so against some difficulty, also related to the treatment:

You see, the good news for the neutrophils is that the Ofatumumab has been attacking the competing lymphocytes, as has the Methylprednisolone. However, while Ofatumumab targets only lymphocytes, Methylprednisolone is not nearly as specific, and it destroys all sorts of white cells, including, of course, some of the neutrophils. So, the greatest change so far, at least in Part A of the clinical trial, has been in the population of lymphocytes, while the numerical change in the neutrophils, while gratifying, has been smaller (but still significant - I am at less risk now of ~bacterial~ infections than I was before treatment started).

OK, just one more graph - I did combine the percent data for both lymphocytes (red curve) and neutrophils (blue curve):

Here the "mirror images effect" can be seen pretty easily, but the best part of the graph is shown way over to the right, where it can be seen that the two curves, going in opposite directions, had actually crossed paths sometime this past week. (And, "May Their Paths Never Cross Again"...) (<smile>)

Categories: Leukemia