« Yikes !!! Hives !!! | Home | Part B, Looking Back at Part A »

Zero Lymphocytes ???

Posted by Frederick Wasti
Jul 30 2012

On last Friday, July 27th, my blood cell count results showed ~zero~ lymphocytes. Huh?

Now, considering that my disease is called Chronic ~Lymphocytic~ Leukemia, that might at first sound like ~great~ news, right? After all, if there literally were zero lymphocytes in my blood, then that would mean that there would have to be zero ~leukemic~ lymphocytes, too, right?

However, on the other hand, since normal lymphocytes do have proper functions to perform, and since they are supposed to normally make up something like a quarter to a third of the total white cells, then ~zero~ percent lymphocytes could not be considered good news after all, right?

Well, of course, I didn't really have zero percent lymphocytes after all - such a test result is merely the result of a sampling error in the way a differential white count is conducted.

Whenever my blood is checked at Dana-Farber, the technician counts the first 100 white cells that he/she sees in the microscope. Since my current lymphocyte count does appear to be about 1% or so (since the blood count results for several other recent days, as well as the results for today, July 30th, all indicate 1% lymphocytes), what occurred on last Friday was that - just by luck - no lymphocytes just happened to be counted amongst the first 100 cells that the technician observed. Perhaps the 101st cell he/she saw might have been a lymphocyte, or maybe the 102nd, but it is only the first 100 cells that will count.

During Part A of my clinical trial, frequent use of Ofatumumab and periodic use of HDMP were used to greatly reduce the lymphocytes in my blood, from about 50,000 per cubic deciliter at the start of Part A down to about 2,000 per cubic deciliter at the end of Part A. (Actually, the lymphocyte mortality was really much greater than those numbers would suggest, since my blood cell counts did not include the very large numbers of lymphocytes that were destroyed while my spleen and lymph nodes were shrinking down - blood cell counts really only show the "tip of the iceberg" and do not show the number of lymphocytes in the lymphatic system nor the number of lymphocytes in the bone marrow.) Ofatumumab and HDMP do most of their lymphocyte destruction in the blood and in the lymphatic system.

Now, during Part B of my clinical trial, frequent use of Alemtuzumab and occasional use of Ofatumumab are being used to attack lymphocytes especially in the bone marrow (which, of course, will also affect the number of lymphocytes in the blood, since lymphocytes move freely between the blood, the lymph nodes and spleen, and the marrow). Alemtuzumab is known for doing a good job at destroying lymphocytes in the bone marrow. And, so far in Part B, my lymphocyte counts have dropped (almost immediately), from approximately 2,000 per cubic deciliter at the end of Part A to typically only about 50 or so per cubic deciliter now (last Friday's "zero" result notwithstanding).

During the time of the trial, other blood cells, which had previously been reduced in numbers due to being crowded out by rampant lymphocyte production in the bone marrow, have been able to bounce back. In particular, my neutrophils, dangerously low at the start of the trial (which in fact was a main reason to start treatment), have risen from less than 1,000 per cubic microliter to currently about 5,000 per cubic microliter, which is a normal number for neutrophils. Note that Ofatumumab, Methylprednisolone, and Alemtuzumab did not directly foster the production of neutrophils - it was their action of destroying large numbers of lymphocytes that made space in my bone marrow so that neutrophils could be produced in normal numbers once again.

So, by looking at the total white cell count for the clinical trial up through today...

...it can be seen that the number of all leukocytes combined has gratifyingly declined from almost 60,000 per cubic deciliter (primarily due to having far too many lymphocytes) to about 5,000 per cubic deciliter (which is actually a "low normal" number).

As for the relative proportions of lymphocytes and neutrophils in my blood, by looking at their percentages during the trial up through today...

...it can be seen that the decimation of lymphocytes - the red curve - has allowed for a reversal of their relative proportions (which is actually an intentional "over-reversal", since, while my neutrophils - the blue curve - have been restored to approximately normal numbers, my lymphocytes have been reduced to ~far~ fewer than normal numbers).

However, just how many of my remaining lymphocytes are ~leukemic~ lymphocytes cannot be determined from any of the above. Obviously, most of the lymphocytes that have been destroyed had to have been leukemic lymphocytes, but - just how many of the ones that are left are actually leukemic? I am still awaiting the results of the genetic testing of bone marrow samples taken at the end of Part A, and those results might provide some indirect evidence that may help to answer that question...

Finally, some additional good news for today's blog entry is that the hives that I reported on in my last entry have not re-occurred - apparently my nightly doses of Benadryl, Zyrtec, and Tylenol do seem, at least so far, to be keeping any allergic reaction to Alemtuzumab under control. (<smile>)

Categories: Leukemia