CLL Support Association
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Decreased WBC's

My husband started Imbruvica 5weeks ago , along with Allopurinol and an Infusion once a month of IVIG. The concern I have is that when he started his WBC's were 265, they are now down to 65, which is great , has anyone else had this experience, to be honest I didn't think it would go down that quickly , uncomfortable because his next follow up is not for 4 weeks and afraid the WBC's will be too Low , Also at what level do you usually stop taking the allopurinol .

So for all the questions , any feed back would be greatly appreciated .

5 Replies
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Great to see a substantual drop in blood counts...however

White blood cell count [WBC] is an inaccurate count in CLL, especially during treatment.

A better count would be the absolute lymphocyte count [ALC] , found in the differentials section of the blood test... often used with the # sign.

Your husband should stay on allopurinol, until his doctor tells him to stop.

~chris

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I agree with Cllcanada,

I had a similar experience with Rituxan, Idelalisib and Venetoclax.

Getting the ALC down is very good. IMO if all of the reductions in the WBC are the ALC going down, there is very little danger of WBC's being "too low". Ibrutinib does not normally cause a sharp crash, so you may see the rate of decrease slow way down.

Watch his ALC (lymphs#) and ANC (neuts#). As long as his ANC stays above 1, there should be no problems, even if the WBC gets below the normal range.

If he had low hemoglobin, hematocrit or platelets they should begin to rise towards normal.

Len

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I dropped very quickly. Low WBC is fine. I am 4 now. Watch ANC . That should not go under 1. If it does they can give a shot to bring it up.

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I went from 238,000 to 10 wbc in a month. About 1/3 of patients respond to Ibrutinib that way.

Virginia

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Thanks everyone

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