Anyone have a dramatic drop in WBC bordering on neutropenia from pelvic radiation (not chemo)?

[StephH72]

Husband is 3/4 of the way through an escalated course of IMRT Prostate bed only radiation (plan was for 33 days but they gave larger doses per day and are trying to do it in 20 days). Today (Saturday) we ended up going to the ER because he was having some strange symptoms. Labs showed his WBC counts, and neutrophil counts have dropped 80% after 15 treatment days. His neutrophils went from 5.4 to 1.04 They said that if they drop to .5 then he will for sure be neutropenic. His Hemoglobin and most of his other blood counts are also WAY below the lowest point in range. The ER Dr talked to the on call oncologist but they said at this point it is just something our radiation oncologist needs to follow and watch. They said Rad Onc may need to stop or pause treatments as husband still has 25% of treatment days left. I’m trying to figure out if this drop is considered a grade 2, 3 or 4 level of toxicity. And wondering if anyone has had this happen from just radiation alone? Any advice on what can or should be done?

[StephH72]

These counts were on high range of normal just 3 weeks ago prior to 15 days of radiation

Labs

[StephH72 in reply to StephH72]

more labs

Labs

[Hidden in reply to StephH72]

My Lymphocytes dropped to .40, at day 22 of 33.

2 weeks after the last day, I recovered to .71

Well see Tuesday will be 6 weeks since RT finished, I'll see if I fully returned then.

I had high Neutrophils before radiation, they are now normal, so technically they went down too!!

[Tall_Allen]

It sometimes happens with whole pelvic radiation, and may take awhile to return to normal. Not much can be done for these slightly low levels.

ncbi.nlm.nih.gov/pmc/articl...

[StephH72 in reply to Tall_Allen]

Thank you Allen. Do you think a pause will be taken with neutrophil levels dropping 80%? Do they measure this to determine grade of toxicity?

[Tall_Allen in reply to StephH72]

Only the absolute neutrophil count (not the percent) is clinically important. May be the RO may want to modify the plan so as to irradiate the big bones less in the remainder - ask him, but levels are not seriously low.

[Hidden]

Stepping in on TA here!!!

My RO stated as long as Neutrophils weren't critical, not to worry about lymphocytes.

But you should ask your RO and MO about your particular circumstance.

[timotur]

I was down 10-15% on WBC/RBC after HDR-BT/IMRT. It took about three years to recover to lower end of normal range.

[Bethpage]

My husband has CLL (chronic lymphocytic leukemia) as a result of 39 salvage RT in mid 2019. One month prior to the beginning of RT, his blood panel was perfect. By January of 2020, he had full blow-sn CLL. It's rare to the max but his case has been confirmed by his MO and by his CLL specialist. I truly hope this is not your husband's situation. His CLL manifested with infection after infection. Even on CLL meds (BTKi), his lymphocyties and Hgb are still lagging.

[treedown]

I had an extreme drop in my Lymphocytes only. My RO and MO stopped my Zytiga and they recovered to just below low normal to low normal. I restarted Zytiga at a lower dose so they were convinced it was the Zytiga causing mine.

[Purple-Bike]

My lymphocytes, but not neutophils, declined drastically, to 0.6 after seven weeks of radiation/brachy boost therapy.. 2.5 years later am still struggling to recover., lymphocytes 0.8 at last count.