brukinsa cll patient

[ceciljr1958]

cll patient that has been on brukinsa for six weeks and with wbc count of 30.3 and lymphocyte absolute count of 27.6 should i be concerned.

[AussieNeil Partner Administrator]

Welcome to our community - I see that you have just joined.

There are two possible matters of concern;

1) Are you becoming neutropenic?

2) Is Brukinsa/zanubrutinib working?

Your WBC is a combination of 5 different types of white blood cells. They are usually separately reported in what's termed the 'Differential', where you should check the absolute counts, not the percentages. See: healthunlocked.com/cllsuppo...

CLL cells fall into the lymphocyte white blood cell category. Per the attached plot for patients on Calcquence/acalabrutinib, a similar drug which also inhibits the BTK enzyme, this inhibition in about 2/3 of cases, can temporarily cause an increase in the blood lymphocyte count and hence the WBC. This is because BTKi drugs block the adhesion signalling that keeps CLL cells in the nodes, spleen and bone marrow, so they can slip into the blood, causing an increase until they die off faster than they are replenished from the nodes, etc. In some cases it can take a long time for the blood lymphocyte count to fall. From studies on the first BTKi drug, Imbruvica/ibrutinib, patients where the lymphocyte count had slowly fallen over a year still did well. You haven't provided any information on trends, which is what needs to be monitored, but I suspect, given the various experiences of other patients as shown in the accompanying plots, you most likely don't have any concerns here.

What's more likely to be of concern, is how many neutrophils you have available to fight off any infections. The difference of 30.3 -27.6 or 2.7 accounts for all your other 4 white blood cell types; neutrophils, basophils, monocytes and eosinophils. Specialists like to see a neutrophil count of over 1.5. So what was your neutrophil count prior to starting treatment and what is it now?

Neil

BTK inhibitors sometimes temporarily cause an increase in lymphocyte/WBC counts

[LeoPa]

Hi. Could you fill up your bio with relevant information about your CLL history? That would make it way easier to help with information you may be seeking. If someone with a similar disease history recognizes a fellow patient having similar disease course and concerns or problems he has experience with, he or she may chime in with advice or information.

[CoachVera55]

Yes I would have to agree with Neil & Leopa, we need more information to really answer your question. My 13 days of full dose of Zanubritinib, WBC & Plts went up initially; WBC 81->118 & Plts 76->108.

After my 6 days off & restarted with 1/2 dose of Acalabrutinib & things moved, but slower while my body tried to heal on its own. Then 10.5 weeks later I had another episode of chestpain & dropped down to Zanubrutinib just 80mg daily. Things stood still. 3 months later once heart & lungs healed & went to 1/2 dose, 80mg twice daily my Hgb 10.8->12.6, WBC 81->9 & Plts 81->109 (they were 105 for a decade)

I think it just takes time & no I would not worry. I love Zanubrutinib because of it effectiveness. I had enlarged neck lymph nodes for 10yrs & they disappeared in the first week. Plus Zanubrutinib has the best ability to reduce the dosage.

Unlike many, I go into Rigors after 4 days off the drug so I can reduce it to the lowest without stopping it completely. The Rigors for me feel like a seizure. You got the good stuff so don’t worry 😉

[DUKELAXDAD]

I started Brukinsa 8/23/23. In 30 days my WBC went up from 221k to 348k .My other numbers were all concerning. NO neutrophils!! I was taking a strong antibiotic as a precaution. The numbers were all getting better within 2 more weeks. Six months after starting treatment WBC was 17K and all other numbers were normal or near normal. When I return in May I expect all will be normal. It’s a great drug, you are lucky!

Take care