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With a CLL diagnosis, knowing more about your immune system could save your life!

AussieNeil profile image
AussieNeilAdministrator
25 Replies

When we are diagnosed with CLL/SLL or the precursor MBL, we need to appreciate that we are immune compromised to some degree. Our immunity also worsens the longer we live with our diagnosis and also with CLL treatment, so infections can significant impact our life expectancy. (Growing older doesn't help either.) I've separately replied here: healthunlocked.com/cllsuppo... with my suggestion of how blood tests can be used to monitor our immune system health.

So to live long and well, we need to learn how to reduce our risk of infection, because infections tend to occur more often, we take longer to recover from them and we are more likely to need antibiotics. Despite the incredible and unprecedented improvements in CLL treatments over the past decade, infections remain the leading cause of death, as determined by long term follow-up, (median 13 years), from the CLL4 trial: hematologyadvisor.com/home/...

"The data from the LRF CLL4 trial included cause of death for 600 patients. 43% (n=258) of patients died from infection. Infections included pneumonia (67%), sepsis (38%), and opportunistic infections (11%)"

This is why being up to date with (non-live) vaccinations can be a life saver. healthunlocked.com/cllsuppo... When our immunity is low, we are likely to succumb to opportunistic infections; bacteria, fungi and viruses always present that we can't fight off without assistance. Some of us may need prophylactic antibiotics during dental procedures and prophylactic antibiotics and antivirals are commonly prescribed during treatment. That's reflected in the 2023 White Paper Compromised: Uncovering the immune-related challenges facing people with chronic lymphocytic leukaemia by the CLL Advocates Network (CLLAN).

healthunlocked.com/cllsuppo...

What Not to Do When You're Immunocompromised

webmd.com/a-to-z-guides/ss/...

Per this Science Direct review article, Infections in patients with chronic lymphocytic leukemia

Infection is a major complication in patients with hematologic malignancies. The increased risk of infection is a consequence of severe immunosuppression caused by the disease itself and its treatment. The effects of cancer chemotherapy on the immune system include bone marrow suppression resulting in neutropenia, mucosal barrier disruption and suppressive effects on T-cells and B-cells. On the other hand, the treatment of hematologic malignancies has changed substantially over the past 15 years, with the introduction of novel therapies that, unlike conventional chemotherapy, have specific targets in neoplastic cells, potentially reducing the deleterious effects of the treatment on host immune defenses. However, infections may occur, either by a predicted effect of these agents on the immune system, or by an unanticipated immunosuppression. Therefore, the introduction of these novel therapies represents new challenges for the proper management of patients with hematologic malignancies.

sciencedirect.com/science/a...

Table 1 in this article provides a useful reference of Drugs and regimens used in the treatment of chronic lymphocytic leukemia and the risk of infection. Before reading more of this comprehensive post, you might like to read         cajunjeff 's "CLL and the immune system for dummies" overview here: healthunlocked.com/cllsuppo...

Protecting ourselves from new infections just requires following these thee basic rules

1. Constant, thorough hand washing and hand sanitizing

2. Constant, thorough cleaning and sanitizing of surfaces that I touch

3. Completely avoiding primary vectors of transmission

medium.com/@amcarter/i-had-...

How to clean your house to prevent the spread of infections

theconversation.com/how-to-...

Being proactive about infections and seeking early medical support may save your life. If you become seriously ill and your doctor's receptionist is unable to offer you an appointment within a day, stress that you are immune compromised and need urgent medical attention. Doctors leave room in their schedule for urgent cases, so you should be able to arrange an appointment fairly promptly. Obviously, don't abuse that privilege. Use it when you have developed a very high temperature or have other symptoms that indicate that your health is significantly deteriorating. If your can't get an urgent appointment with your doctor or another doctor in the same practice with access to your case notes, go to a hospital emergency/ER/A&E. This is particularly crucial if you are under treatment, or are neutropenic or suspect you may be developing sepsis (see below for more information on this very dangerous situation).

Following are some selected references and past posts that provide an insight into what most people take for granted, but we do at our peril - a well working immune system.

The Immune System

healthunlocked.com/cllsuppo...

The Human Immune System (A Graphic)

healthunlocked.com/cllsuppo...

- How the immune system works (Excellent overview)

White blood cells, the immune response, immunity, immune system disorders

medicalnewstoday.com/articl...

Fantastic 9 minute video of a lecture on the innate and adaptive (humoral and cell mediated) parts of our immune system and how they all work together

youtu.be/LSYED-7riNY

- What do healthy white blood cells do?

healthunlocked.com/cllsuppo...

- Great animation illustrating how our immune system works

youtu.be/AucZlvEv29Y

- Five life lessons from your immune system

Explains how different parts of your immune system work together. Note the comment about T-cell exhaustion, which is one of the ways CLL cripples our immune system - and we can't prevent that happening.

theconversation.com/five-li...

CLL - a Cancer of the Immune System

Note that the precursor to CLL, Monoclonal B-Lymphocytosis can also impact our immune system.

healthunlocked.com/cllsuppo...

Dr. Neil Kay (Mayo Clinic), Immune function in CLL: What is wrong and why?

healthunlocked.com/cllsuppo...

healthunlocked.com/cllsuppo...

Managing the risk of infection in patients with Chronic Lymphocytic Leukaemia treated with targeted therapies

healthunlocked.com/cllsuppo...

1) Bacterial infections

Our neutrophil white blood cells primarily protect us, but we are more likely to need antibiotics to assist our immune system overcome them. There's evidence that CLL impairs the function of neutrophils: healthunlocked.com/cllsuppo... Finding the most effective antibiotic requires growing a culture from sampling nasal secretions, urine, pus, blood, etc, to identify the bacteria responsible.

2) Viral infections

With the exception of a few specific antiviral drugs generally given during treatment, we are reliant on our immune system to overcome viral infections. Antibiotics won't help unless we develop a secondary bacterial infection, so avoidance is key, aided by good hand washing. Coughing and particularly sneezing are very effective means of spreading viral infections and you need to be at least 2 metres/6 feet away to minimise your risk of infection. Unfortunately masks work better at containing coughs and sneezes smithsonianmag.com/smart-ne... than providing protection, but a well fitted N95/FFP2 or better mask may help.

- Latest COVID-19 guide for immunocompromised blood cancer patients from the International COVID-19 Blood Cancer Coalition (ICBCC)

healthunlocked.com/cllsuppo...

- Measles risk

healthunlocked.com/cllsuppo...

3) Fungus among us

Fungal infections are difficult to treat and tend to take a long time to overcome. Prevention is a far better alternative and this post provides a wealth of very important information about fungal infections.

healthunlocked.com/cllsuppo...

healthunlocked.com/cllsuppo...

healthunlocked.com/cllsuppo... (specifically Ibrutinib)

How did I catch a cold when isolated?

Ever wondered why you still became ill (not just with a cold) despite taking extreme care to avoid infections? Some bugs can survive a long time in our environment before infecting us and it can also take a while for an infection to develop. Opportunistic infections can arise when our immune system is particularly challenged.

healthunlocked.com/cllsuppo...

Boosting your immune system

- Vaccinations

healthunlocked.com/cllsuppo...

- An example of why it's important. Opportunistic infections take advantage of our weakened immune systems, with pneumonia a potential killer

healthunlocked.com/cllsuppo......

What is Pneumonia?

healthunlocked.com/cllsuppo....

Professor Chris Whitty explains the history of vaccinations and how they work, while acknowledging that they are not always a suitable way to tackle a disease.

healthunlocked.com/cllsuppo...

(Prof Chris Whitty is the Chief Medical Officer (CMO) for England, the UK Government's Chief Medical Adviser, Chief Scientific Adviser at the Department of Health and Social Care and head of the National Institute for Health Research (NIHR). He is also Gresham Professor of Physics (the term for medicine when the post was created in 1597) at Gresham College.)

Interview Video (from February 2021)

gresham.ac.uk/lectures-and-...

Presentation Notes

s3-eu-west-1.amazonaws.com/...

- Exercise! It's as easy as a walk in the park!

Four minute overview of how your immune system works and how exercise boosts it.

m.youtube.com/watch?v=MLw2Y...

healthunlocked.com/cllsuppo...

healthunlocked.com/cllsuppo...

- IgG Infusions

Low immunoglobulin counts - IgA, IgG, IgM, (hypogammaglobulinemia) is common in CLL healthunlocked.com/cllsuppo... If you have enough severe infections, your specialist may prescribe IgG infusions. These can be done intravenously every 4 weeks or more (IVIG), generally requiring around 5 hours in a hospital or clinic or subcutaneously - usually done weekly and at home. Subcutaneous infusions have the advantages of less side effects and better maintenance of your immunoglobulin protective levels. There's no need to schedule vaccinations around IgG infusions; that requirement is only relevant for live vaccinations, which we shouldn't have.

Ontario study showing benefits

healthunlocked.com/cllsuppo...

uptodate.com/contents/intra...

healthunlocked.com/cllsuppo...

healthunlocked.com/cllsuppo...

More member experiences of IG Replacement Therapyhealthunlocked.com/cllsuppo... US qualifying requirements (also see other reply by SeymourB in this post)

healthunlocked.com/cllsuppo...

healthunlocked.com/cllsuppo...

Don't forget your dental health!

healthunlocked.com/cllsuppo...

Dental health is further discussed in this post, which includes a link to the American Dental Association protocol on antibiotic prophylaxis healthunlocked.com/cllsuppo...

CLL treatments and the immune system

healthunlocked.com/cllsuppo...

Dr. Adrian Wiestner of the National Institutes of Health on the impact of CLL on the immune system and post treatment recovery (from AS 2018)

cllsociety.org/2019/10/ash-...

Determining your risk of infection - blood tests

You might like to track your neutrophil and immunoglobulin blood test counts or during treatment, your lymphocyte counts, using a spreadsheet template:

healthunlocked.com/cllsuppo...

This reference explains the purpose of different blood tests:

healthunlocked.com/cllsuppo...

healthunlocked.com/cllsuppo...

Protecting yourself against infections when neutropenic

Many CLL treatments cause low neutrophil counts and it can also develop when you are treatment naïve healthunlocked.com/cllsuppo...

Neutrophils normally make up about two thirds of our white blood cells and protect us from bacterial, fungal and viral infections. Sometimes CLL bone marrow infiltration, an enlarged spleen or even an auto-immune complication can cause neutropenia. Your specialist may prescribe Granulocyte - Colony Stimulating Factor (G-CSF) injections (Granix, Neulasta, Neupogen, Filgrastim, Zarzio, etc). These are injected into the subcutaneous stomach skin via a very fine needle and boost neutrophil production. If your bone marrow has completely stopped making neutrophils, it takes about 10 days for your neutrophil count to rise, but the usual response is much faster.

Check absolute neutrophil counts, not percentages. This is why: healthunlocked.com/cllsuppo...

- Low White Blood Cell (Neutrophil) Count Precautions

healthunlocked.com/cllsuppo...

We should also reschedule vaccinations if our neutrophil count is under 0.5

healthunlocked.com/cllsuppo...

- Tips on G-CSF self administration

healthunlocked.com/cllsuppo...

- Safe Eating for Poor Immune Function - Beyond the Neutropenic Diet

Over the last decade or so, cancer nutritionists have increasingly questioned whether classical neutropenic diets are the best option for neutropenic patients. This 2021 research from the University of Cologne, the centre of the German CLL study group validates this concern, determining from a propensity score–matched case-control study that:-

• The benefits of a germ-free diet for neutropenic patients with cancer are scarce.

• Food restrictions may increase malnutrition and gastrointestinal side-effects.

• Standard diets do not increase infectious complications in neutropenic patients.

• Incidence of diarrhoea and nausea can be reduced by standard diets.

• Implementation of standard diets for neutropenic patients with cancer is safe.

ejcancer.com/article/S0959-...

From 2014: healthunlocked.com/cllsuppo...

Adopting a Neutropenic Lifestyle if your are chronically neutropenic healthunlocked.com/cllsuppo...

- Late Onset Neutropenia (LON) after obinutuzumab or rituximab treatment

healthunlocked.com/cllsuppo...

- Sepsis/Febrile Neutropenia/Neutropenic Fever - blood poisoning (This potentially life threatening condition requires URGENT IV antibiotic treatment)

This can be triggered by infections caused by bacteria, viruses and parasites. Early symptoms of sepsis include fast breathing or a fast heartbeat, high or low temperature, chills and shivering. It is one of the leading fatal situations in CLL, (the other is pneumonia) and early recognition and treatment is important. Discuss the signs with your family and care partner... we are at higher risk at all times, but particularly during and post treatment... all treatments.

If you develop these symptoms, go to a hospital Emergency/ER/A&E where you know you will be promptly seen. Stress your symptoms and you should be treated with the same degree of urgency as someone with a suspected heart attack - it is that serious!

healthunlocked.com/cllsuppo...

healthunlocked.com/cllsuppo...

healthunlocked.com/cllsuppo...

Dr. Erel Joffee, lymphoma specialist with Memorial Sloan Kettering Cancer Center, covers the above in ~4 minutes: youtu.be/ScXCNf_WUZM

Incidentally, unexplained fevers, weight loss and night sweats are known as B Symptoms and can be indicative that your CLL is becoming more active. See: healthunlocked.com/cllsuppo....

Shingles and why prompt treatment is crucial

healthunlocked.com/cllsuppo....

healthunlocked.com/cllsuppo....

healthunlocked.com/cllsuppo...

Skin Conditions (from Patient Power)

Covers skin cancer, hives, hair loss and texture changes, nail changes and fissuring of fingertips and bruising with BTK inhibitors, (acalabrutinib, ibrutinib, zanubrutinib, etc), skin dryness and neuropathy with venetoclax, scalp changes (folliculitis, tenderness, itch, pain, burning of the scalp), rosacea, bug bites, (bug bite hypersensitivity is seen in about 10% of people with CLL).

healthunlocked.com/cllsuppo...

Urinary Tract Infections (UTIs)

healthunlocked.com/cllsuppo...

healthunlocked.com/cllsuppo...

Secondary Cancers

Unfortunately, because CLL adversely impacts our immune system, including the activity of our T cells that patrol for secondary cancers and can eliminate them before they become established, we are at higher risk of developing a secondary cancer. cancer.org/cancer/chronic-l...

We are particularly prone to skin cancers, so it's wise to take precautions with sun exposure and have regular skin checks, particularly now that new CLL treatments mean that we are living longer. See for example Impact of chronic lymphocytic leukaemia on melanoma outcomes: A retrospective case-control study onlinelibrary.wiley.com/doi...

"A total of 56 patients with melanoma with CLL were matched 1:1 to patients without CLL for age, date of diagnosis, gender and melanoma tumour, node, metastasis (TNM) stage. Multivariate analysis found CLL was associated with significantly worse melanoma-specific mortality (hazard ratio [HR] 2.46, 95% confidence interval [CI] 1.27–4.74, p = 0.007) and recurrence (HR 3.44, 95% CI 1.79–6.63, p < 0.001). Patients with CLL had poor immunotherapy tolerance and prior CLL treatment was not associated with melanoma outcomes."

Also, don't overlook the potential contribution of CT scans to your risk of developing secondary cancers. CLL specialists now use CT scans only when absolutely necessary. If you are in a clinical trial, see if you can arrange for an MRI scan in place of a CT scan, or argue for having them less often. See: cllsociety.org/2016/03/ct-s...

Ibrutinib (and other 'brutinib's') Bleeding Risk in Patients With CLL Receiving Mohs Surgery

Surgical treatment of (skin) cancers can be complicated not only because of potential underlying thrombocytopenia, which occurs in about 5% of untreated CLL patients, but also because of the increased risk for bleeding that is associated with the use of the Bruton tyrosine kinase inhibitor.

...those treated with ibrutinib had the highest rates of complications among all of the patients (40.6%), with all of their complications involving bleeding-related events. (This is why standard advice is to stop taking ibrutinib for at least 3 to 7 days pre- and post-surgery.)

medscape.com/viewarticle/97...

Richter's Syndrome/Transformation

Briefly, Richter's Syndrome occurs when a more aggressive lymphoma, usually diffuse large B cell lymphoma (DLBCL) and occasionally Hodgkins Lymphoma, arises in the background of CLL. It can be clonally related or de novo. There's around a 2 to 10% chance of this happening, with a higher incidence more common with specific prognostic markers.

Biology and Treatment Options (March 2022) healthunlocked.com/cllsuppo...

Overview of current treatment options (March 2022)

healthunlocked.com/cllsuppo...

cllsociety.org/2019/06/ash-...

healthunlocked.com/cllsuppo...

Last updated 1st March 2024

Neil

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AussieNeil profile image
AussieNeil
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25 Replies
Justasheet1 profile image
Justasheet1

Wow, Neil this is awesome. Great work!!!

🤧💉👍🍻

Jeff

AussieNeil profile image
AussieNeilAdministrator in reply to Justasheet1

It's a compilation of previous good posts on this very important topic, so your thanks are for many. I've just compiled it for a pinned post :) .

A very popular subsequent post: Can You Boost Your Immune System? where Dr Jen Gunter interviewd Dr. Katherine Gundling (Immunologogist) and Tim Caulfield (Medical legal issues), can be found here:

healthunlocked.com/cllsuppo...

Neil

Lasweetpea profile image
Lasweetpea

Thank you so so much for compiling all of these. There is so much to learn and understand about CLL/SLL.

Blessings to you.

mrsjsmith profile image
mrsjsmith

Thank you Neil.

Colettex

Wroxham profile image
Wroxham

Thanks Neil. Great to have it all together.

Sue

mrsjsmith profile image
mrsjsmith in reply to Wroxham

Cheery bedtime reading ! 🤔

Wroxham profile image
Wroxham in reply to mrsjsmith

I'm too fatigued for bedtime reading

Colette!!😓

mrsjsmith profile image
mrsjsmith in reply to Wroxham

Me too ! Fall asleep with the lights on and then have to get up at 3am to turn them off. But I always think I am going to read at least a chapter a night 🤔

Smakwater profile image
Smakwater

Video's like the response animation are great. I always feel like a Phd for ten minutes after watching one. Whereas after reading a scholarly publication, I feel a bit jerky, like just before a final exam.

Lot's of good reading. Thank you for the complication.

JM

jdolinger profile image
jdolinger

Great information.....thank you Neil

lexie profile image
lexie

I am constantly amazed at how much useful current content is found on this site. This is so well organized!

roszika profile image
roszika

So comprehensive , always impressed with your postings

Mystic75 profile image
Mystic75

Thank you, Neil - this is great!!

bennevisplace profile image
bennevisplace

Brilliant post this, full of useful information. Is it pinned?

AussieNeil profile image
AussieNeilAdministrator in reply to bennevisplace

Yes. :) More pinned posts here: healthunlocked.com/cllsuppo...

Floxxy profile image
Floxxy

Thank you so much, so helpful.

CLLerinOz profile image
CLLerinOzAdministratorVolunteer

In a presentation at this week's SOHO 2021 conference, Carsten Utoft Niemann, MD, PhD, said that 'patients with chronic lymphocytic leukemia (CLL) are at an increased risk for infection whether they are in the premalignant state of monoclonal B lymphocytosis (MBL), during active surveillance for those (who) are treatment naïve, or are on active treatment.'

In promising news, he explained that, with the help of the machine learning–based algorithm CLL Treatment-Infection Model (CLL-TIM) . . . he and his colleagues 'hope to learn whether the natural history of immune dysfunction and infections in CLL can be changed.' Let's hope they find out it can be!

Although great advances have been made in treatments for CLL patients, Niemann explained that 'mortality due to infection in these patients has not changed in 4 decades' and 'infections are now the leading cause of death among patients with CLL'.

Interestingly, he said that the risk of having a serious infection is higher within the first 5 years. “The 30-day mortality [rate] upon a serious infection for patient diagnosed with CLL is 10%; the 1-year mortality [rate] is only 11% for patients starting treatment for CLL even though 50% of them will have a serious infection after starting treatment. This means that infections are actually more dangerous for patients with CLL who are untreated.”

He is a co-investigator for the 'phase 2 PREVent-ACaLL trial (NCT03868722) which will use the CLL-TIM algorithm to determine whether short term treatment with the BTK inhibitor acalabrutinib (Calquence) plus the BCL-2 inhibitor venetoclax (Venclexta) can improve immune function and reduce the risk for infection compared to observation in patients with high-risk, newly diagnosed CLL.

Niemann says that the aim of this investigation is 'to turn back the CLL into a normal immune function, and the outcome here is actually infection-free, treatment-free survival.'

Further details can be found in these summaries of the presentation:

onclive.com/view/controllin...

targetedonc.com/view/infect...

The presentation paper can be found here:

clml-soho2021.elsevierdigit...

JigFettler profile image
JigFettlerVolunteer in reply to CLLerinOz

Valuable insights. Reassuring that our Medical leaders are pushing on to understand better our disease.

Thank you.

CLLerinOz profile image
CLLerinOzAdministratorVolunteer in reply to JigFettler

Very reassuring🤞

CORONOVIRUS profile image
CORONOVIRUS

As I still consider myself fairly new to the CLL journey, this was great information. Thank you so very much. I love this site.

YelvertonDevon profile image
YelvertonDevon

Thank you.

Feldman profile image
Feldman

A Great source of helpful information Neil. your dedication and knowledge that you provide on this site is very much appreciated. Thank you!

Sumoldbloke profile image
Sumoldbloke

Wow that is the most useful post I could imagine. My neutrophils have dropped to 0.4 after three full doses of Obinutuzumab I am due another one on Tuesday. Meantimes I have had two injections of FILGRASTIM. After the first no change results of second on Monday so I guess Tuesdays infusion may be postponed . Just in first week of Venetoclax. I am totally avoiding everyone for the time being. Taking plenty of exercise but zero social mixing.

It will take a while to digest all the information in your post. Thank you

AussieNeil profile image
AussieNeilAdministrator

In thinking about how our immune system protects us, I'm wondering if the analogy of a medieval walled city might assist. The actual protective work is having high, hard to penetrate walls in place (our skin), with entry points defended (white blood cells and immunoglobulins), lookouts posted and patrols operating, looking for new threats (macrophages (derived from monocytes), memory B and T cells). Our blood is kept sterile and is primarily the means of transit for defenders moving to their defensive positions. Taking a snapshot of defender movements on the roads (Complete Blood Count) gives an indication of the numbers involved in defending the city (our body), but a deeper analysis is needed to identify their specific roles. An immunophenotype blood test reports the number of B lymphocytes, helper, cytotoxic T and natural killer lymphocytes. A report of our antibody/immunoglobulin counts (IgA, IgM and IgG) tells us the quantity, but not the relevance to the local infection threats, which change over time. So tracking trends in the following can give us an indication of our immunity, but not the level of 'training and effectiveness' or how well the different components of our immune system work together as a team against an enemy attack. For that, our best measure is how often we have infections and how quickly we recover from them. (This is why immune boosting supplements don't necessarily boost our immune system; they typically increase the number and activity of our lymphocytes, but not how well our immune system works overall.)



Immune System Health Indicators

- Neutrophil counts (ANC)

- Lymphocyte counts (ALC)

- Other white blood cell counts combined (So WBC - ANC - ALC)

- Immunoglobulin counts (IgA, IgG, IgM) - Ususally checked less frequently than other blood cell counts

- How often we are ill and how long it takes us to recover, compared to others in similar situations to us

In more detail:

Neutrophils are our primary means of defense against bacterial, fungal and viral attacks. They use the blood stream to move from the bone marrow to our tissues, where they follow chemical signals to move to infection sites (say a skin cut). It's their accumulation around the infection site which causes redness and swelling. Pus is mostly dead neutrophils, full of consumed invaders and dead body cells. The neutrophil count in a healthy individual, comprises about 60% [40 -70%] of the white blood cell count, followed by the lymphocyte count [22 - 44%], then monocytes [up to 7%], eosinophils [up to 4%] and basophils [up to 1%]. The different white blood cell types have varying roles, for example eosinophils deal with parasites, allergies and cancer. It's because the numbers of monocytes, eosinophils and basophils vary considerably and make up a small percentage of our white blood cell count, that I suggested just tracking neutrophils, lymphocytes and other white blood cells to monitor protection levels.

In a healthy individual, about 5 to 15% of our lymphocytes should be B cells (markers CD19+CD5), with the remainder T cells (CD3) and Natural Killer cells. The T cells are subdivided into Helper T cells (CD4), which work with new B cells in germinal centers in our nodes to assist with the maturation of B cells into plasma cells and memory B cells (via somatic hypermutation) and Cytotoxic T cells (CD8) which recognise and kill body cells that have been invaded by a virus or are precancerous. A immunophenotype test gives the breakdown of lymphocytes into the aforementioned categories. See healthunlocked.com/cllsuppo...

CLL tends to drive an increase in cytotoxic T cell population, so the normal CD4:CD8 T cell ratio can become reversed. Unfortunately, CLL also drives the T cells to exhaustion with cytokine signalling, so they don't work as well - hence our increased risk of cancers, particularly skin cancer. This is in part why counts don't correlate well with immunity.

When we have an infection or vaccination, macrophages take bits of the killed invaders (or what's in the vaccination - e.g. spike proteins) to the nearest lymph nodes. The lymph node germinal centres swell as B and T cells clone and change their receptors to try and find a locking match. The resulting memory B and T cells continuously circulate in the blood, looking for re-infection. The resulting plasma B cells take up residence in the bone marrow, where they first begin making IgM, then class switch to produce the other immunoglobulin types/sub classes. Unfortunately, CLL suppresses immunoglobulin plasma cell production, so with CLL, IgA, IgG and IgM counts tend to drop over time and with CLL treatment (because current CLL treatments unfortunately kill healthy B cells as well as CLL cells). That suppression lifts when our CLL tumour has been eliminated, but then we need new B cells to mature to produce new plasma cells. After a vaccination or infection, we should see a lift in IgM within 1 to 2 weeks. Later the IgA and IgG levels should increase. IgA does its protective work in membranes in our respiratory, digestive and genitourinary tracts. Again, absolute immunoglobulin counts are only a rough guide of our protection; it's how well our Ig titres match against community circulating infections and any received infection load that determines our level of protection. For example, if we are exposed to someone shedding a new COVID-19 variant, if we've had a recent booster or COVID-19 infection, wearing a respirator is going to greatly reduce the viral load we may breathe in. We may have enough closely matching immunoglobulins to totally neutralise the breathed in virus - and never know we were exposed. If not, memory T and B cells should quickly respond, killing infected body cells and producing plasma cells which make better matching immunoglobulins to neutralise the virus respectively. Higher affinity memory B cells for the new variant then remain circulating in the blood.

Tracking our ALC after we finish treatment gives us a rough idea of how our immune system recovery is going, but we need a further breakdown from an immunophenotype test to determine our helper/cytotoxic T cell numbers, to identify when B cells return and whether any of them are CLL cells.

Neil

Lavinia-Blue profile image
Lavinia-Blue

I also think if immune boosting (increasing cell counts) did work it would be short lived, that is for the healthy system. Cells that don’t die, not so much.

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maintain/improve our fitness: https://healthunlocked.com/cllsupport/posts/137917456/an-exercise-pill