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W&W Once Again (#2)

Posted by Frederick Wasti
Dec 11 2012

Well, yesterday was a treatment day at Dana-Farber. The schedule was pretty typical for how most of the Part C days should be (and, in fact, it would be typical for how many of the Part B days had been as well), where I have blood drawn for testing, and later (after the blood test results are back) I have an injection of Alemtuzumab and an examination by Michele Walsh, my D-F nurse practitioner. (On the other hand, once a month in Part B, and once every two months in Part C, the treatment day is longer and more involved because of a long Ofatumumab infusion and addition pre-meds.) I did feel somewhat "treated" later on at home yesterday, but I felt pretty good by the evening. "A piece of cake"...

My main focus for yesterday, though, was on seeing my blood test results, which would be the first results showing any changes (if any) that might be occurring as a result of the reduced (i.e., stretched out) Part C schedule of being treated only once every other week. My concern, of course, is that the counts might have shifted somewhat, specifically showing more lymphocytes perhaps.

Well, the ~good~ news is that the blood test results were once again rather "boring" (<smile>). For the 100 white cells counted this time, 99 were neutrophils and (still) only one was a lymphocyte (and the 100 did not include any monocyte this particular time). After doing all of the advanced math necessarily involved, I can now say that I have 99% neutrophils and 1% lymphocytes.

So, the results from yesterday were basically the same as they have been for a number of months (since shortly after Part B began) - typically only about 1% lymphocytes, with the rest being all or almost all neutrophils, with an occasional monocyte showing up (or, on rare occasions, perhaps even an eosinophil). So, there is no significant change in my differential white cell count from my peripheral blood, but, of course, I don't know yet what could possibly be changing in the bone marrow and/or in the lymph nodes and spleen (but hopefully no changes are happening in those places as well).

Of course, it is worth remembering that these percentages are still quite unbalanced. Ordinarily, neutrophils are supposed to make up 49% to 79% of the white blood cells (and not as much as 98% or 99%), and lymphocytes are supposed to make up as much as 11% to 38% of the white cells (and certainly not just 1% or so). Of course, these numbers (and I took the normal range numbers from a D-F lab results printout) show the relative proportion of the white blood cells and not the actual numbers. The absolute number of neutrophils is now pretty close to normal (perhaps "high normal") -- it is the scarcity of lymphocytes that makes the percentages so lopsided.

However, today I would also like to take a look at my red blood cells and my platelets for a change. With leukemia, it is the white cells that, not surprisingly, get the most attention, but red cells and platelets can be negatively impacted by leukemic cells crowding out other cells in the marrow, and/or they can be negatively impacted by the treatment regimen used to reduce those leukemic cells (but also causing "collateral damage").

For my red blood cells, there really does not seem to have been too much of an impact because of CLL or because of treatment. Looking at my red cell counts during the trial (and I have added upper and lower normal limit lines for the "official" D-F range of 4.2 to 5.6 millions of cells per microliter),...

...it can be seen that my red cells have been a bit on the low side during treatment (and, in fact, dipped a bit more during the summer, probably while the Alemtuzumab was busy "beating up" my marrow), but, if we look at my red cell counts historically (from as far back as I have records),...

...it is clear that I have always (or, at least for a long time) had "low normal" red cell counts (although, admittedly, the CLL and/or the treatment for it, may have lowered the counts a bit more). However, I don't really think too much about the red cell counts - i.e., they're basically OK, or, at least, "good 'nuf".

On the other hand, the platelet counts have been more of a concern throughout the trial. In truth, they are too low, as a graph of my platelet count during treatment will show:

However, while they are low (and below the normal range most of the time over the last few months), my platelet counts are not quite at a dangerous level, where I would have to be treated for a too-low platelet count and/or have to suspend my CLL treatment for a while to allow them to recover somewhat. (Michele Walsh, when we were discussing my platelet counts yesterday, mentioned that Alemtuzumab is rough on platelets, and, in fact, some patients have had to suspend treatment for a while simply because of that, but that my platelet counts have been "high" enough that doing so has not been necessary in my case).

Actually, looking at historical data, my platelet counts, like the red cell counts, have always (or, at least for some time now) been at a "low normal" level:

Hopefully, in Part C, having treatments much less frequently, perhaps my red cells and my platelets can improve somewhat. What I need is just enough treatment to keep my CLL in check, without too negatively impacting red cell and platelet production in the bone marrow. Too much treatment would hurt the production of many types of cells in the marrow, but, if the CLL were to return, that would also hurt such production, as the leukemic lymphocytes crowded out other cells there, so it's a balancing act, I guess.

I'll be watching and waiting...

Categories: Leukemia