Atypical lymphocytes (AtyLym) on blood test - does it have any diagnostic meaning (for non-CLL patients, CLL W&W patients, CLL patients with treatment, if it makes a difference)?
Atypical lymphocytes (AtyLym) on a blood test may be shown as a percentage of WBC or as absolute numbers (or both).
When observed over time (i.e. monthly blood checks over several months), AtyLym can be stable, grow, drop. Does AtyLym change over time have any diagnostic meaning (again - for non-CLL patients, CLL W&W patients, CLL patients with treatment, if it makes a difference)?
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mantana
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When I saw your question I recalled a video on Patient Power by Dr. Susan LeClair and then in text for the CLL Society cllsociety.org/2019/03/whit...
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" The term "atypical" was first coined in the 1920 by a physician called Downey. He thought that these cells were the cause of a specific condition he was investigating. In the 1960s, it turned out that he was totally incorrect. These cells are lymphocytes that are actually fighting off disease—which is the exact opposite of being the disease. Since then, the correct term for these cells is "reactive" since that more correctly reflects what they do. Having a few could man that you were exposed to a cold virus or have a mild viral infection or were exposed to (and successfully fought off) any number of bacteria. These cells could also be seen if a serious condition (for example, some malignancy) has a strong antigenic component and the cells are trying to react to that.."
Perhaps some clarifications on why "atypical lymphocytes" were interesting to me. I'm still W&W.
When I was diagnosed, I had 0.5% atypical lymphocytes. Then their percentage was growing. History of atypical lymphocyte percentages in my blood results:
2019-10-29 - 0.5%
2019-12-20 - 5.5%
2019-01-24 - 4.5%
2019-02-28 - 10.0%
2020-04-03 - 8.0%
2020-05-29 - 12.0%
April 2020 result shown highest lymphocyte counts I've ever had, 18.83 (and more than double of what I had in October 2019, 8.57). Towards end of May, I started having skin issues mainly around my hand and foot fingers which I never had in my life (later diagnosed as sweat eczema, dyshidrosis - en.wikipedia.org/wiki/Dyshi... - it looked similar, although not as bad as on these photos; later skin biopsy, of which I got the results on 2020-07-10, did not find anything else).
I got really scared. I knew I can't start my therapy in Japan, because I'm about to leave to Germany in a few months and it could take a while before I arrange insurance etc... I imagine interrupting CLL treatment may have serious consequences.
Knowing I can't start any treatment soon, my blood counts getting worse (on the other hand, they are still quite OK most people would say), having skin issues I've never had in my life - I've resorted to "alternative medicine".
Around the middle of May 2020, I've started drinking a lot of tea with increased catechins. At the beginning of June, started my "EGCG & curcumin overdose" experiment.
I know it's a bit too early to jump into any conclusions, could well be a coincidence, but just for myself, I've seen the following changes:
- skin issues gone
- atypical lymphocytes now 0% (confirmed 0% on blood tests on 2020-06-15 and 2020-07-10)
- lymphocytes down to 10.42
However, I've decided not to continue my "EGCG & curcumin overdose" experiment for the following reasons:
- main reason is that I have a different chronic disease, hepatitis B (100x increased liver cancer risk when compared to healthy people); some reports show EGCG can damage the liver... it is the liver cancer (a really deadly cancer) I should be afraid of! My liver test, ALT, increased from 29 on 2020-06-15 to 45 on 2020-07-10 ("healthy" range being 6 to 30); for the record, on 2019-10-28 my ALT was worse, 57
- nausea after taking EGCG (I was taking it on an empty stomach to improve absorption)
- EGCG/curcumin is not likely to cure CLL
- CLL might seem like a well maintainable (hopefully curable for most of us!) disease nowadays, as shown by recent studies where venetoclax is combined with other drugs
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Anyway, coming back to atypical lymphocytes - I've made some more "internet research" on them, if anyone feels bored reading my stories, please read below.
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Atypical lymphocytes are also called reactive lymphocytes, or variant lymphocytes:
Atypical lymphocytes, or “variant” lymphocytes as they are currently referred to, are defined as non-malignant lymphocytes that are in response to non-specific hematopoietic stress as seen with various conditions/disorders. Immunizations, viral infections, and hypersensitivity responses (drug reactions, insect bites) may be sources of such stress. In general, a white blood cell differential showing greater than 20% variant lymphocytes would be reportable and might require further examination.
Reactive lymphocytes are usually associated with viral illnesses, but they can also be present as a result of drug reactions (such as phenytoin), immunizations, radiation, and hormonal causes (such as stress and Addison's disease), as well as some autoimmune disorders (such as rheumatoid arthritis).
Some pathogen-related causes include:
Epstein–Barr virus
Cytomegalovirus
Toxoplasma gondi
Treponema pallidum (syphilis)
Streptococcus agalactiae (group B streptococci)
Hepatitis C
Hantavirus
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Some ranges of atypical lymphocytes and their meanings:
The atypical lymphocyte is a normal constituent of the human peripheral blood. In normal man 12 per cent or less (mean 7.5 per cent) of the mononuclear cells are atypical lymphocytes. In what is defined as probable atypical lymphocytosis 13 to 19 per cent of the mononuclear cells are atypical lymphocytes. Atypical lymphocytosis is definite when 20 per cent or more of the mononuclear cells are atypical lymphocytes.
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Finally, a PDF called "Typical and Atypical Chronic Lymphocytic Leukemia Differ
Clinically and Immunophenotypically" - the focus of this document are not atypical lymphocytes, but atypical CLL.
It is of some interest to me, as my CLL is a bit atypical, i.e. it is CD5 negative (more than 90% of people with CLL have CD5 positive).
Note that every such study might have a different definition of what atypical lymphocyte is, and what atypical CLL is.
For this study, they've selected patients with more than 10% of atypical lymphocytes:
I am W&W for 9 years, Trisomy 12, mutated. ALC around 50K, reactive lymphs varying from 4K to over 7K. CD5+CD19+ 83%. I've had reactive lymphocytes reported for several years now, plus above normal monocytes and even above normal neutrophils at times. At least they're not low! The numbers on my automatic CBCs are very different from manual CBCs for monos and neuts.
I've been to NIH for their History of CLL study, and reviewed actual photos of my reactive lymphs with Dr. Marti there.
One of the characteristics he showed me was Ballerina Skirt cytoplasm. Here are some photos, though nobody has said that I currently have mononucleosis or EBV. I did have it as a teen. My understanding is that EBV can lurk in the nucleus.
I can only speculate that I have a chronic, subclinical infection. Maybe the EBV is making a comeback? My submandibular lymph nodes are only slightly swollen, but I do have a 5cm pre-auricular node, which I have dubbed Gillespie, because I do get dizzy, and play a trumpet a bit.
Dr. Marti pointed out that automatic instruments can be fooled by some unusual looking cells, because the cells diffract the various laser beams in unusual ways, and size of cells is only statistically a predictor of cell type. Lymphocytes, both B and T, go through growth stages when reacting to infection, hence the name reactive lymphocytes. Depending on the instrument, the results may be automatically flagged for manual review.
Dr. Marti did not seem concerned, and said that he has seen this in other patients, and that it did not seem to herald anything in particular. My CLL has continued its slow progression. I have no fever, but I do have fairly significant fatigue. I have IBS-C, and blepharitis. I have eczema in my feet, for which I was prescribed a steroid ointment that does provide relief. I continue to have trouble with left ear aches.
As to the liver effects with EGCG and curcumin, I had a major gall bladder attack 2 /12 years ago after taking a teaspoon or so of turmeric, a sprinkle of black pepper, and bread and butter along with chicken and sausage gumbo while I had a severe sinus infection. It was a spontaneous experiment. I ended up getting very itchy all over, and my liver enzymes were elevated. I ended up having a cholecystectomy. I believe the turmeric aggravated existing gall stones, and the blockage and possibly the turmeric itself elevated my enzymes. I only took the turmeric for a few days before having the gall bladder attack.
The really odd thing is that my reactive lymphs started either with that sinus infection or the cholecystitis. I had had CBCs one month previous that did not show them, and the CBC for the doctor visit for the gall bladder pain, and every CBC since, showed them. The sinus infection continued for 2 months, along with complete blockage of the affected ear, despite multiple rounds of antibiotics. I had a sinus culture that did show bacteria, and a change in antibiotic eventually knocked it back. A few months later, a new sinus infection - different bacteria - set in and lasted again for a couple of months.
Based on those infections, plus failed titres for pneumococcal pneumonia vaccine, I went on SCIG (SubCutaneous ImmunoGlobulin). SCIG did not affect the reactive lymphocyte numbers either way. I've gone off of SCIG for the summer, because I seldom venture out these days due to COVID-19, except for medical appointments. I live in New Orleans.
Consumerlabs.com has some good links to actual studies for both EGCG and curcumin, plus side effects, and brand reviews. But it requires a subscription to view them. It's worth it to me.
I know that the ALC doubling time is worrisome to you. If you do not have night sweats or other B symptoms, or major swollen lymph nodes, and your ALC <30K or so, most CLL specialists would not start treatment based on the doubling time alone.
That last PDF is pretty old. Atypical CLL is an outgroup - it's not a single thing in itself, it just means you're not ... typical. I sort of feel that way myself, being trisomy 12. But I am CD5+ like most trisomy 12's.
From 2017, here's an underpowered, observational paper on 17 patients with CD5 negative CLL:
> Consumerlabs.com has some good links to actual studies for both EGCG and curcumin, plus side effects, and brand reviews.
Oh, EGCG, and curcumin!
With current state of medical research, it's really hard to find a disease where EGCG and curcumin don't seemingly help! Any virus, including HIV, any types of cancer of heart disease... there seems to exist a published medical research which proves the benefits of both EGCG and curcumin for literally any kind of disease.
Don't take my word for it. Google for any disease + EGCG, or + curcumin, and most likely some study available on ncbi.nlm.nih.gov / pubmed.ncbi.nlm.nih.gov / academic.oup.com pops up; possibly something ongoing on clinicaltrials.gov.
However, if you look closer, you will see most of these research was made in vitro, but not so much on humans.
Some curcumin research papers were simply a fraud (particularly by Bharat Aggarwal).
In the end, more research is needed - I'll drink plenty of green tea in the meantime.
Readers here have been sharing studies and experiences of EGCG and curcumin for several years now.
I agree that EGCG and curcumin are mostly fashionable and folklore, anecdotal - hence the unregulated market.
There's some proof of effects for a few things, but also side effects to consider. They are not fully benign. Scientific studies tend to use specific strength doses, while consumer market is wild and hearsay.
I mention the ConsumerLabs link, because you mentioned EGCG and crcumin, plus your liver status. I think ConsumerLabs does a good job of reviewing ingredients, strngths, and contaminants. Plus they offer links to actual studies from reputable journals.
Green tea is a nice beverage. My brother in Japan turned me on to it. I'm sure you can get better quality there than over here. The tea at the various shrines I visited in Kamakura is so green, I've never seen the equivalent here.
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