WBC count technical q

[Lawand1]

when we get our WBC count, will it pick up and count WBC storing in lymph nodes and spleen or would these be additional to the blood count? Thanks, hope that makes sense.

[AussieNeil Administrator]

Your total CLL tumour load is all your accumulated CLL cells in your blood (typically comprising more and more of your lymphocyte count over time), your spleen, nodes, bone marrow and sometimes other organs, most often your liver, but CLL cells can accumulate anywhere. We know from our experience with BTK and PI3K delta inhibitor drugs (idelalisib etc), that these disrupt the adhesion mechanism that keeps CLL cells in nodes, so that they move into the blood. Likewise something in cannabis can do the opposite, encouraging CLL cells to move from the blood into our nodes. The heterogeneity of how CLL accumulation varies from person to person, from the SLL presentation, where the cancerous cells are hard to find in the blood and the 11q bulky node presentation, through to cases where people can have very high lymphocyte counts with very little nodal involvement.

Neil

[Lawand1 in reply to AussieNeil]

Thanks Neil. After 8 years on Ibrutinib I went mono therapy Venetoclax last November. After it wiped out my neutrophils and hospitalised me with infection/pneumonia/sepsis it was reduced to 300mg and G-CSF three times a week down to once per week now. My total WBC has hovered around 10 with neutrophils around 5. I can’t feel any nodes, not could my Dr, but I sense my spleen so wonder if I’m being a hypochondriac or is it possible that my spleen is starting to hoard lymphocytes even with relatively low counts. I don’t expect an answer! 😂 thanks as always for taking time.

[AussieNeil Administrator in reply to Lawand1]

Short answer to your initial question is that your WBC won't pick up changes in your spleen size. If your doctor has checked for nodes, they should have also checked if they can feel if your spleen has enlarged enough to protrude below your rib cage on your left, i.e. whether it is 'tippable'. Your spleen is a specialised lymph node, so not being able to feel any other lymph nodes that could have enlarged is a good sign. Likewise your very healthy neutrophil count, albeit supported by reducing G-CSF shots.

Neil

[bennevisplace in reply to Lawand1]

Hi Lawand1. If your spleen was significantly enlarged by accumulation of CLL cells before treatment, it may not return to its "normal" volume after treatment. That's the story my haematologist gave me anyway. I finished treatment March 2020 and the left side of my abdomen remains just a little distended compared with the right side. ALC is between 1 and 2.

[SeymourB]

Lawand1 -

The best they can do for the spleen is a CT, MRI, or maybe ultrasound to measure the size of it. They don't usually do a spleen biopsy to count cells because it's dangerous and has somewhat complicated structure.

They can also do a BMB (Bone Marrow Biopsy), to see how many normal or CLL cells remain there. Usually the BMB is considered the best quality data possible, and best indicator of remaining disease.

=seymour=