High neutrophils low lymphocytes low IGg

[Downriver555]

Hi all, I am 1 year out from treatment of gazyva and venetaclax. My blood work after treatment showed I was MRD negative. I changed insurance companies and I no longer qualify for IGG. (They require below 200). I watch every 3 months as my Igg levels trend downward. Currently they are 446mg/dl. What is also unusual is my neutrophils have jumped up to 83.4% and absolute 8.1. My lymphocyte count had dropped down to 11% with absolute at 1.1 When I did a little investigating of the high neutrophils and low lymphocyte ratio, most of the info was centered around the following info " high neutrophils and low lymphocytes might mean the bodys immune system can't respond well to cancer. So a high level of neutrophils plus a low level of lymphocytes could reflect an environment that promotes cancer progression" . What I don't understand is the immune system is absolutely critical in fighting cancer. Once the cll became neg. why do theyl et my immune system go unchecked to just let the cancer cells take back over. I see my Dr today and I am looking for advice how to direct the appropriate questions as to see how I can stop this trend and if I should be overly concerned about my cll returning quicker than expected as there is very little IGG to keep the cancer cells in check.

Thanks for any advice in advance

[lankisterguy Volunteer]

Hi Downriver555,-

I'm not medically trained, so I can only suggest some ways to refine your approach to get answers from your doctor.

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First you may want to ignore the % numbers on your blood tests. They don't add any information, only used to calculate the Absolute numbers.

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Having your ALC at 1.1 is very much like mine has been for the past 5 years (I'm on Venetoclax daily). On my chart the low normal is 1.0, and I have been as low as 0.4, but most of the time between 1.0 and 1.2. I suspect your doctor will say that is a good sign that you are still in remission from the Venetoclax treating your CLL.

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As far as I know IGG does not have an effect on controlling cancer or CLL, only bacterial or viral infections. And your insurance may agree to restarting IVIG if you have frequent infections, especially sinus or lung problems.

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Your ANC being above 7.0 may be worthy of a discussion, but the doctor will likely ask about recent infections, vaccinations or other things that could trigger an immune reaction. I would expect that your doctor will suggest waiting for a few future blood test results before taking any action. I have never heard of any medical intervention that can lower the ANC, so it may mean tracking down the cause of the immune disturbance - separate from CLL or cancer.

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Len

[Downriver555 in reply to lankisterguy]

Thank you for you feed back. I always believed your immune system and Igg played an important role in suppressing cancer cells. Now I will have to do some more research so I don't get too bent out of shape that my IGg is getting lower:)Thanks again

[lankisterguy Volunteer in reply to Downriver555]

Hi Downriver555,-

I agree that if we had a perfectly working immune system we would not have any cancer.

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But the immune system is incredibly complex and the IgG, IgA, IgM is only a part of that complex system, and the antibodies are looking for specific characteristics of bacteria or viruses. see:

rchsd.org/health-articles/b...

merckmanuals.com/-/media/Ma...

medlineplus.gov/lab-tests/i...

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Other members might be able to better explain the portions of the immune system that guard against cancer cells, but I believe it involves detecting errors in the cell replication process, when a cell divides and the new cell is not a perfect duplicate of its parent. That detection system then destroys the bad copy to prevents any further replication.

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Len

[AussieNeil Administrator]

Hi, Len has given you a great answer. Please, never, ever look at percentages when you have CLL, because they just confuse and mislead. (See healthunlocked.com/cllsuppo... - the principle applies in reverse)

All that matters is that you have enough white cells to protect you from infections and cancer. When any white blood cell type is either higher or lower than usual, the percentages of the other white cell types are distorted, only because the percentage total must equal 100% by definition. Before treatment, our lymphocyte count is typically much higher than usual and after successful treatment, typically lower for a year or two, even more. That's what you are mostly observing in your results. The typical neutrophil range is up to 8.0 in many labs. Ranges are specifically set with 5% of the healthy population having results outside the reference range. Being 0.1 above the upper reference range may be right for you, or you may just have had infection, or exercised before your blood test. (Exercise temporarily 'shakes' neutrophils out of the spleen into the blood stream, to protect against infections you might get during exercise).

Your low lymphocyte count is typical for someone who has had successful treatment - per you achieving uMRD. You probably still don't have any B-cells in your lymphocyte count and your T and NK cells are may still be a bit lower than usual, because both venetoclax and Gazyva also slightly reduce these, plus it can take a year or so for the Gazyva from your last infusion to disappear while it keeps on removing B-cells. CLL exhausts T cells, which is why we are at increased risk of some cancers, particularly skin cancers when we have CLL. That's no longer a concern for you.

IgG is highly unlikely to work against cancer cells, unless it is also removing healthy cells, i.e. you have an autoimmune condition. Cancer cells and healthy cells are so very, very nearly identical, which is why Gazyva, and artificial immunoglobulin like IgG, removes healthy lymphocytes as well as CLL lymphocytes. An IgG count of 446mg/dl (thanks for the units) a year after your treatment is actually fairly good!

Neil

[Downriver555 in reply to AussieNeil]

Neil, your response is so right on it!!! Now that I think back on what I did the day of my lab draw makes sense. That morning I fasted till noon and went on a steep 2 1/2hr hike up a steep Mtn on a super hot day. I had my labs drawn 1 1/2 hrs after returning and eating a bit before I went in. You have no idea how much relief I had knowing all of my other CBC blood counts were normal including red and white cells. I see my Doc today so hopefully it goes well. I appreciate this web site more than you know. Thanks

Susan

[Downriver555 in reply to Downriver555]

I just received my results from my covid antibodies test and I am negative for antibodies after getting 2 phizer shots Dr. Said to start on the moderna series. One step forward another step backwards. Ugh!!!!!!