My husband has been on Ibrutinib for 2 years now, and has taking Bactrim and Acyclovir along with it. Up until four months ago, his numbers have been in the more normal range. He feels well, and had a good CT scan in June. But in the last month his WBC, neutrophils and platelets have fallen drastically. His neutrophils are at .5, his platelets are 96, and his WBC is 2.1. The doctor took him off Ibrutinib for going on 4 weeks, with no change. He just had a bone marrow biopsy last Thursday, and we will have results in 7 days or so. Doctor said they will do another FISH panel. The rest of his vitals are great and he has no underlying conditions. What would the FISH panel show that would be different from his first one? Could the neutropenia be drug induced and cause bone marrow depression? Why would his lactic count be elevated? He is 11q deleted, unmutated. His lymphocytes are in the low normal range, and his LDH is normal.
I am very scared about the next appt. Even more worried because of Covid-19. Pete is self isolating at home, and I have also restricted my activities.
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kathymac52
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Hi Kathymac52. Bactrim can cause neutropenia. I work used to work with liver transplant patients, and we routinely gave them prophylactic bactrim. We did see some neutropenia with our patients.
Chronic: Use of Bactrim at high doses and/or for extended periods of time may cause bone marrow depression manifested as thrombocytopenia, leukopenia and/or megaloblastic anemia. (Thrombocytopenia and leukopenia are of course low platelets and low white blood cell counts).Other antibiotics can also cause neutropenia.
The bone marrow biopsy will hopefully show what is causing your husband's bone marrow depression. The FISH panel will show whether he still has CLL in his bone marrow (quite likely after just two years on Ibrutinib) and whether the CLL has developed any sub-clones.
Given you live in the USA, I would recommend you see if you can make use of the CLL Society's Expert Access program for a free second opinion from a recognised CLL specialist cllsociety.org/cll-society-... It's positive news that Pete feels well and had good CT scan results only 3 months ago.
As to your question about repeating the FiSH test, CLL can undergo clonal evolution, meaning the mutation profile can change overtime. This can happen on its own or in response to treatment. It doesn’t always happen but can. It is important to check, especially when someone is having problems, because it can affect future treatment choices. If your husband, who had an 11q mutation, has now acquired another mutation as well, the best choices for drugs might change.
If you are asking about the low counts, with your doctors okay he might hold the Bactrim (depends on why he's on it) and see if the counts recover. Bone marrow biopsy will give much info too
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weekly transfusions going on 4 months
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Help with results
First day on IBRUTINIB
