Bendamustine and Rituximab and Low Lymphocyte Count

prorich, I can't tell you anything about B+R treatment, however the low lymphocyte levels can be a problem if they are because of infection somewhere in your system. It would be a good idea to talk with your Dr. about those levels and ask if all is okay. Please do contact your Drs team with any questions you have during treatment. These medicines, while being touted as wonderful and so terrific so fast, are quite potent and patients deserve to know what is going on with their situations. Let them know you want to know about whatever questions you may have.

Hopefully, some who have experience with B+R will be on to share with you.

Sounds very low. As with any chemo, avoid germs, undercooked food or raw vegetables. What did your doctor say?

Your numbers will bounce back but mine were never that low. Mine got to .18 (ALC) after round 5. You’re only at round 2.

Jeff

My understanding is that in general since before treatment most of our lymphocytes are cll anyway and any healthy ones tend to be swamped out and not very effective that having a low lymphocyte count is an indicator of success. It is also why we take cotrimoxaxole acyclovir and in some cases azithromycin. Because it does mean that we don’t produce that many antibodies (‘made by healthy lymphocytes). For sure you need your antibody levels monitored and if they drop and you are getting infections IVIG (replacement therapy) may be indicated.

As always do discuss your personal

Situation with your doctors. .

I finished 6 rounds of BR just over a month ago. From the 2nd round onwards my ALC has been 0.20 to 0.40 and is now 0.24. Saw my consultant last week and he wasn't concerned and said would gradually come up.

However, neutrophils below 1.00 delayed 5th round treatment. They are now just over 1.00. I feel very well and have not had any infections, apart from a nasty cough which has now gone.

Good luck with your treatment. Joy

So having finished 6 rounds of BR in February I can tell you my lymphs are in the cellar. Just came through another bout with pneumonia and it really kicked my butt. I did see my PCP and ONC. Have a follow up with the PCP in a couple days and another chest x-ray. I watch my numbers but follow the medical advice I am given. If you are not 100% confident in your dr and don't trust his or her opinion I would recommend a second opinion.

Hello Profich,

After 4 cycles of FCR in 2010, I started Bendamustine/ Rituximab in May 2013.

After just 1 cycle my ALC was 0.6. (WBC 2.1)My consultant thought this was good so I had no more cycles until June 2016 when my ALC had risen to 83. After another cycle of B & R my ALC was 1.1 (WBC 4.3) so again I stopped. My ALC rose to 78 by April 19.

My ALCs were not quite as low as yours but your doctor doesn’t think it’s a problem so don’t worry.

Good luck

Benny

I agree with AdrianUK. Isn't the whole point of chemo to destroy our abnormal lymphocytes?

I'm on a different treatment regime....C/O, and after the first session my lymphocytes plummeted. I couldn't believe how fast it worked! I'm in cycle 4 now, and they hover between 0.5 and 1. All of my other cells have remained within normal range, including neutrophils.

I'm on various prophylactic drugs, and have been coping pretty well. My haematologist is very happy with progress so far.

Best to talk it over with your doctor, for peace of mind. Best of luck!

Anne.

Hello profrich

I suspect my doctor would agree with your doctor. At end of 2nd cycle of B+R, I was at Absolute Neutrophils - 1.65 and Absolute Lymphocyte - 1.46. I had Neulasta shots starting after 2nd cycle of B+R. I completed all 6 cycles and now have blood labs in normal range. hang in there, blessings.

profrich,

There is an expected trend at each stage of treatment that your doctor is measuring based on trial data and treatment guidelines. Although some results will be better or less than expected, it may be acceptable given other aspects of your health and blood counts.

It is common for ALC to drop as the drugs are causing cell death, however, low neutrophils “≤ 1.5” is a primary concern for infection risk.

Avoid conditions that present risks for infection, and consider discussing what options your doctor will offer in the event your neutrophil count becomes critically low, e.g., G-CSF injection, or postponing treatment.

JM

Soon after two cycles of BR my lymphocytes and neutrophils count went down. My Onco

gave me Nupogen to stimulate Neutrophils. But my Eosinophils count gone up to 46.

I went through almost all investigations to findout the reason for increased number of Eosinophils. Besides I have developed skin itch mainly over face neck and shoulders. After a skin Biopsy the Dermatologist diagnosed that I have Eosinophilic Cellulitis (Ofuji Foliculittis Disease) as part of reaction to Bendamustine. Eventually my further BR Cycles were discontinued. Currently I am in short remission. Once it relapses, my Onco suggest that I should l start a non chemo drugs either Ibrutunib or other. If my experience can give you some insight. Please do have a second opinion from a good Haemato and Onco or any CLL expert.