I finished O August 2023 and at 1 yr on Ven with 1 more year of V planned as I was treated for relapse.
I also have severe Cubital Tunnel
Syndrome in both elbows that has cause numbness, and weakness in the hands as well as pain that has progressed to the point of interning with almost every activity that involves flexing the elbow, like computer work or even using ski poles, holding phone, sleeping etc.
I have 2 teeth that need extraction
Platelets 100-120, ANC > 2,500, Hbg >15, and ALC about 800-1200 for 6 consecutive months.
Just wondering about infections and poor healing with Surgery??????
Anyone have any experience or info on Surgery in this setting?
thx
Skipro
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skipro
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Thanks for the update! Have you had IGg levels done? If it's low they could 'boost' you up before you had surgery. I've had them last summer after I started getting more infections and it did help.
When I had arthroscopic knee surgery last year, the surgeon stated he wanted my platelets above 150. That was his only concern, I had no antibiotic prophylaxis (neuts were normal). The preop platelet verification CBC uncovered what was an AIHA. Surgery was put out a week, it was thought a drug was causing the AIHA, and the anemia rapidly reversed once the drug was D/C'd. I had the surgery, no sequelae apparently.
You probably won't have any B-cells, the Obin will have done for them. B-cells don't recover for about a year from last Obin infusion. Your Lymph count will be mainly T and NK cells.
Platelets are low for surgery and neuts are near bottom of normal range.
You may need a transfusion of platelets or have to discontinue Ven to see if the platelets increase >150.
As for venetoclax, “prior to surgery, patients should receive granulocyte colony-stimulating factor for neutropenia, blood transfusions for anemia, and platelet transfusions for thrombocytopenia to maintain procedural parameters.”
And this "year" number is only for "most patients". Some patients show recovery as early as 9 months, others took longer than a year and half. Several had not recovered by the end of the study below. The median for this small study, for a renal disease, was 78 weeks. Most of the patients recovered after week 93.
In CLL patients specifically, data from 2015 noted some patients had not recovered after 18 months. Which parallels the renal study results.
"Initial CD19 B-cell recovery was observed in some patients approximately 9 months after the last obinutuzumab dose. At 18 months of follow-up, some patients remain B-cell depleted."
There was mention of median lymphopenia of about 10 months after treatment, with 39% remaining lymphopenic at 2 years in this Australian study, but it was not obinituzumab monotherapy. Interstingly, this study indicated neither the the depth of lymphopenia nor the duration of lymphopenia correlated with infection. So simply being B cell depleted for a longer time isn't as important as us patients may think.
"Median time to recovery (>1x109/L) was 10 months post EOT; 39% of pts remained lymphopenic (4% grade 3/4) at 2 yrs (Figure 1B). However, neither lymphopenia nadir nor duration correlated with infection post EOT (OR 0.53 p=0.26 and 0.97 p=0.29 respectively) and the relationship between lymphocyte nadir and OI was not significant (OR 0.09 p=0.053)."
(Note: EOT is End of Treatment and OI is Overall Infection, for those not wanting to read the medicalese"
Another thing I read is that in the early studies, obin apparently didn't affect immune globulin levels greatly from baseline in the majority of patients. However, if one's levels happen to be low after treatment or during recovery, for whatever reason, that would indicate a higher infection risk.
So whether or not our B cells recover in a timely manner, shouldn't be a source of stress IMO! If your counts stay "below normal" for an extended time, and you aren't symptomatic, and your docs aren't concerned, please don't worry.
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V+O treatment 
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Question about V & O
