anemia

[Concerneddaughter123]

hi everyone. My dad is receiving Firmagon injections every 4 weeks and is on Zytiga daily. His Red blood cells have been dropping since starting on this regimen four months ago. He had radiation a few years back, I think about 80 treatments in total to different areas. His MO is concerned he has leukemia now based on his RBC levels. Has anyone else had their red blood cell count drop on this medication regimen? What are the odds of leukemia after radiation? I can’t find great information online. Thank you.

[Concerneddaughter123]

also to note, the MO is so concerned she is putting in a stat bone marrow biopsy. His hemoglobin and hematocrit have increased over the last month and his WBCs are within normal range.

[SpencerBoy11 in reply to Concerneddaughter123]

The bone marrow biopsy should provide the answers. I started thee same way; radiation can cause myelodysplastic syndromes (MDS). Basically your blood factory doesn't work right. Think it often goes undx.

[Tonyliv]

I’ve been borderline anemic previously. An iron tablet (ferrous sulphate) daily helps boost the hb levels.

[dhccpa in reply to Tonyliv]

We're you low on iron blood tests prior to taking iron?

[Tonyliv in reply to dhccpa]

Yes. My hb level was around 130, 135, but it dropped to about 113 and my oncologist said I was borderline anemic. An iron tablet a day pulled me back up.

[dhccpa in reply to Tonyliv]

Yes, I'm anemic on hormone therapy as well. But my iron and ferritin levels are in normal range.

[Wings-of-Eagles in reply to Tonyliv]

interesting since two oncologists at cancer centers recomneded to me NOT to take and iron suplements,,or Magnesium

[SimMartin]

I have been on hormones (zoladex) following RT for G9 localised - my Hb and ht have both been superseded and my doctor also panicked but it seems it’s a recognised response and isn’t iron related - I was told that unless below 10 it is not a problem - assuming it iss as just isolated Hb and not other issues

[hansjd]

Like your dad, my husband is also on Firmagon (6+ years) and Zytiga (3 1/2 years). As soon as he started ADT his haemoglobin dropped to a level somewhat below the lower limit of the standard range. It fluctuates month to month, but remains pretty constant within a narrow band. His MO is not concerned as he is still well above anemic level. He's constantly active and it doesn't seem to affect him except perhaps he has a few more naps in between working hard on various projects. His WBC counts are normal. He definitely does not have leukemia which manifests as an abnormal number and type of WBC. As your dad's WBC are also normal, it seems to me to be highly unlikely he has leukemia. The lower RBC count is just one known side effect of ADT treatment. All the best.

[vintage42]

"... Zytiga daily... Red blood cells have been dropping since starting on this regimen four months ago... had radiation a few years back... Has anyone else had their red blood cell count drop on this medication regimen? What are the odds of leukemia after radiation?"

My RBC dropped, and Googling indicates that prostate radiation can cause leukemia but very rarely.

Age 81. I had radiation in 2021 (prostate) and 2023 (pelvic nodes), and have been on Zytiga 4 months (and Orgovyx for 6 months). The Zytiga effects will be closely monitored for 6 months, so 2 to go. So far, my RBC has dropped from 4.49 to 4.13 which is just below the normal range. WBC remains unaffected.

[Anatalya]

My husband's RBC is low also, and has been the whole time he's been on Zytiga. His hemotocrit is also low, but his ferratin (?) level is normal. Doc hasn't really said, but all that tells me he has iron, and each cell is carrying the proper amount, but his blood cells are not numerous enough to make the level normal. Doc has only said taking iron supp will not help. I suspect because of his lack of RBC.

Doc only says it's "from the medication," so I'm assuming the Zytiga is the culprit.

[j-o-h-n]

Can radiation cause leukemia?

ChatGPT

Yes, radiation can cause leukemia. Exposure to high levels of ionizing radiation is a known risk factor for developing leukemia, a type of cancer that affects the blood and bone marrow. Here's a detailed explanation:

How Radiation Exposure Leads to Leukemia

Mechanism of Radiation-Induced Leukemia:

DNA Damage: Ionizing radiation can damage the DNA in cells. When this damage occurs in the bone marrow, it can lead to mutations in the blood-forming cells.

Uncontrolled Cell Growth: These mutations can disrupt normal cell growth and division, potentially leading to the development of leukemia.

Types of Radiation Exposure:

Medical Treatments: High-dose radiation therapy used to treat other cancers can increase the risk of leukemia, particularly acute myeloid leukemia (AML).

Occupational Exposure: Workers in certain industries (e.g., nuclear power plants, radiology) who are exposed to high levels of radiation over time are at increased risk.

Environmental Exposure: Exposure to high levels of radiation from environmental sources, such as nuclear accidents or atomic bomb blasts, has been linked to higher rates of leukemia.

Latency Period:

Leukemia can develop several years after exposure to high levels of radiation. The latency period for radiation-induced leukemia typically ranges from 5 to 15 years.

Types of Leukemia Associated with Radiation Exposure

Acute Myeloid Leukemia (AML): This is the most common type of leukemia associated with radiation exposure.

Acute Lymphoblastic Leukemia (ALL): Less commonly associated but still a potential risk.

Chronic Myeloid Leukemia (CML): There is some evidence suggesting a link between radiation exposure and CML.

Risk Factors and Considerations

Dose-Response Relationship: The risk of developing leukemia increases with the dose of radiation exposure. Higher doses and prolonged exposure elevate the risk.

Age at Exposure: Younger individuals are generally more susceptible to the effects of radiation, and the risk of leukemia may be higher if exposure occurs at a young age.

Genetic Susceptibility: Some individuals may be genetically predisposed to developing leukemia after radiation exposure.

Mitigating the Risk

Minimizing Exposure: Limit exposure to ionizing radiation whenever possible, especially in medical settings.

Protective Measures: Use appropriate shielding and follow safety protocols in occupational settings to reduce exposure.

Regular Monitoring: Individuals with a history of significant radiation exposure should undergo regular health screenings for early detection of leukemia and other cancers.

Conclusion

While radiation is a necessary and effective treatment for many medical conditions, it does come with risks, including the potential to cause leukemia. Understanding these risks helps in making informed decisions about treatment options and taking appropriate precautions to minimize exposure. If you have concerns about radiation exposure and the risk of leukemia, it is important to discuss them with your healthcare provider.

Good Luck, Good Health and Good Humor.

j-o-h-n

[pe43]

ADT and abiraterone/Zytiga reduce the androgen testosterone, and this can lead to low hemoglobin. See this article:

patientpower.info/navigatin...

"Androgens support the production of erythropoietin, which is a hormone that supports red blood cell production. However, hormone therapies for prostate cancer suppress androgens, lowering red blood cell production and hemoglobin levels."

This is not related to low iron. Low iron causes iron-deficiency anemia (IDA).

[Cactus297]

My son had problems with Firmagon. He stopped it after the first injection because it was so painful. He’s done ok on generic Zytiga, prednisone and Lupron. He was diagnosed just before his 50th birthday and it’s been almost two years and his 3 month checkups have been okay thus far. He also had five weeks of IMRT radiation about 3 months after starting the three medecines. No serious problems with his bloodwork yet. Did your dad have any serious health issues before starting the medicines? As far as we know, my son did not. It’s really just test to test for all of us and it’s really stressful. Please keep us posted on how he’s progressing and thanks for writing.

[Concerneddaughter123 in reply to Cactus297]

I’m so sorry about your son. My dad was diagnosed at age 65, but was very healthy and had no health issues. He also struggled with Firmagon, but after a few doses, the side effects got much easier for him.

[Cactus297]

Each patient reacts to these powerful medications so differently. I learned quite a bit just reading the replies. So many knowledgeable people here. I hope things work out well for your Dad and you. Every turn in the road is so difficult for all of us.

[Concerneddaughter123]

it is different for everyone. It is great to be able to get on here and learn to help us all make more informed decisions. I hope the same for your son and your family.