Doubled wbc count good or bad?

[marcelarr]

So my father in laws latest test results came back after a week of chlorambucil... Wbc down to 51 (from 100), platelets down to 10 (from 40) at diagnosis ...

He claims he read somewhere that doubling wbc count is a good prognosis... My pc is down with a virus infestation, so I was wondering if anyone can shed a light on the issue? Wbc doubling good or bad?

[AussieNeil Administrator]

I'm not sure Marcelarr of the intent of your question, given your father in law's WBC has halved after treatment. When your are in Watch and Wait, once your Absolute Lymphocyte Count goes over 30 (or 30,000 in the USA), then haematologists consider doubling time one important factor in deciding to initiate treatment. If it doubles in less than a year, then that's a sign that the CLL is beginning to grow rapidly and treatment is not far away. Doubling in less than 6 months would be a trigger to start treatment. Given an ALC can bounce around quite a bit, it is the overall trend that is important. Basically, a longer time between doubling correlates with a longer time to treatment. CLL lymphocytes are quite small, so they don't cause the kinds of problems seen with other blood cancers with larger cell sizes, but they do accumulate in the nodes, spleen and bone marrow (and elsewhere), causing eventual problems that lead to the need for treatment. If you look in the Pinned Posts, you'll see a post "How high can you go and what does it matter, that covers the impact of high white cell counts in CLL patients.

So, in short, a slow doubling time is one good prognostic factor, but there are many others. We need to also remember that B-lymphocytes in the blood are just easy to measure. They may not give a true picture of the tumour burden, particularly in a patient that has plenty of bulky nodes, maybe in the abdominal cavity, where the patient would not be aware of them. Some patients can have massive spleens too, but that is easy to detect. With CLL, everyone is different.

It's good to see that your father in law is responding to treatment, though he will need more transfusions to help him through the low platelet stage. Platelets only last up to a week, so don't be surprised to hear he'll need regular transfusions for a while.

Neil

[marcelarr in reply to AussieNeil]

A thousand times thanks.

[Cllcanada Top Poster CURE Hero in reply to marcelarr]

I think you mean halving... a drop in white blood cell count (WBC) from 100K to 51K... this is good... the chlorambucil is doing its job...

However you should track the absolute lymphocyte count (ALC), not the white blood cell count (WBC), because the white blood cell count (WBC) is 60% neutrophils and these might drop and pull down the white blood cell count (WBC), which would not be an indication of drop in B lymphocytes...

absolute lymphocyte count (ALC) is what you need to view, to see the treatment effect...

~chris

[marcelarr in reply to Cllcanada]

Thanks the lab tests did not include this, I did mean doubling because that is what he thought, that a doubled wbc count was a good prognosis.

[AussieNeil Administrator in reply to marcelarr]

You won't see ALC on blood test results, but you should see a row entry for Lymphocytes. Typically there should be a White Cell Count/WBC column with the total white cell count, then under it a breakdown of the counts of the major white cell types that should add up to the WBC total. Unfortunately there's no international standard on naming, but it should be in the order below, along with the result and the normal ranges for each type:

Neutrophils

Lymphocytes

Monocytes

Eosinophils

Basophils

Lymphocytes are further split into B-Lymphocytes (the cancerous cells your father in law has) and T-Lymphocytes. These can't be told apart in a simple blood test, so are just lumped in together. You can pretty well forget about white blood cells other than the neutrophils and the Lymphocytes. There are posts and videos on this site with more of an explanation if you are interested, but basically you just need to keep an eye on these:

Red Blood cells (RBC) and Haemoglobin (you get puffed/tired if they are too low)

Platelets (Needed to stop bleeding. Low you bruise easily, too high you get clots)

Neutrophils (Needed to prevent infection - first responders)

Lymphocytes (Secondary responders and long term immunity)

Neil

[marcelarr in reply to AussieNeil]

Thanks so much Neil, neutrophils are low (1.5), and lymphocytes getting lower as I mentioned 50, all the others are low.

[AussieNeil Administrator in reply to marcelarr]

I wouldn't be worried about his neutrophil levels unless they get below a third of what they are now. Falls in blood counts are a normal part of chemotheraphy and a margin is allowed for when choosing to start therapy with CLL when circumstances permit.

[marcelarr in reply to AussieNeil]

Thanks... The platelets are what he is most worried about.

[Cllcanada Top Poster CURE Hero in reply to marcelarr]

In the U.S. and sometimes Canada, the absolute numbers appear at the botton of the Complete Blood Report in a section marked 'Differentials'

there are usually two sets of figures, the percent % and the absolute... often marked with a #

It might say... for example...

LYMPH 42.3 #

or ABS LYMPH 42.3

or # LYMPH 42.3

Sometimes there are only percents, and in that case you need to calculate the absolute number..

ABS lymphocytes = white blood cell count (WBC)

x the percentage of lymphocytes/100

[marcelarr in reply to Cllcanada]

Thanks working on an excel sheet to do this as I think it will be important.

[Cllcanada Top Poster CURE Hero in reply to marcelarr]

There are a number of Excel templates around... for CLL bloodwork etc. I'm certain someone here has one to send you...

[AussieNeil Administrator in reply to marcelarr]

If you send me a PM with your email address I'll send you an updated tracking spreadsheet. I've been meaning to work on a few outstanding plotting issues, mostly minor, but until very recently I only had a very underpowered netbook with a small, low resolution screen, which made it tedious work The spreadsheet is much improved on the original.

Also, with respect to your original question, I suspect your father in law may be thinking of what happens with the newer, non chemo drugs, like Ibrutinib. Researchers were surprised to see patients' ALCs climb rapidly early in treatment. They weren't expecting that to happen. They now know that it is because these drugs interfere with the way the cancerous B-cells form a protective micro-environment around themselves in lymph nodes and the B-cells get flushed out into the blood stream, where they are more vulnerable and die off. It doesn't always happen and I don't know how that correlates with how a patient responds long term. It doesn't happen with your father in law's treatment.

[Quarry]

As your father in law is in treatment (which I have not yet gone through), I can't comment on his status.

However, in general the important thing is the trend over a reasonable time-scale (as Neil says a doubling over a year is a sign that treatment might be required, but only a sign)

Many things can affect a single measurement - mine had almost doubled over 6 months at last consultation. I then pointed out I was fighting off a cold and the haematologist quickly dismissed the reading ('ah cold, that would be why') and said 'see you in 6 months'. I am fully expecting it to be back down next time I see her (provided I am infection-free at the time!).

[marcelarr in reply to Quarry]

Thanks very much for this... At the time of his diagnosis he had persistent cough and sinusitis, he still had sinusitis and is on antibiotics for it.