My husband has CLL, he has also been treated for metastatic melanoma which from his latest CT scan is NED. He will receive his last immunotherapy infusion next week. We are beyond grateful. However his blood work taken yesterday showed and increase in his WBC from 14.5 last month to the recent 19.9. All other blood work is normal except for platelets at 147. CT scan showed a decrease in CLL lymph nodes and normal size spleen. I would appreciate any thoughts you would share on these findings.
Blessings to all.
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There are five different main types of white blood cells included in your WBC count, so you need to look at the 'Differential' section of the report to determine what's really happening. See the discussion about this in this pinned post.healthunlocked.com/cllsuppo...
What changes happened in his absolute lymphocyte and neutrophil counts respectively?
So, to clarify, the last immunotherapy your husband is receiving is Opdualag (nivolumab and relatlimab-rmbw) to treat his metastatic melanoma. It's great that he now has no evidence of disease with respect to his melamoma - what a relief!
You haven't shared your husband's neutrophil and absolute lymphocyte changes in the past month, so given the healthy neutrophil range is typically from 2 to 8, I don't know how much his lymphocyte count, which includes the measure of his CLL blood tumour has changed. However, it's his total CLL tumour load which is important and you note that a "CT scan showed a decrease in CLL lymph nodes and normal size spleen". So the tumour load in his nodes has decreased and some of that decrease could be responsible for what seems to be a slight increase in his lymphocyte count, given the overall increase in his WBC. CLL specialists don't pay close attention to changes in the lymphocyte count until it has climbed over 30, when doubling time is more closely monitored to check it's not doubling faster than every 6 months.
I've attached lymphocyte count plots of 21 people in CLL stage 0/1, from which you can see that this degree of change from month to month is fairly typical. Just keep monitoring the trend in his lymphocyte count and if the doubling time gets below 6 months, particularly his absolute lymphocyte count climbs above 30, expect his CLL specialist to monitor him more closely for other indicators of active disease that could trigger the need for treatment. These triggers are covered in this pinned post: healthunlocked.com/cllsuppo...
I see from your post last month that his platelet count has recovered from a recent low of 127 to 147, which is encouraging.
Neil
Lymphocyte counts in stage 0/1 CLL can bounce around considerably.
Yes, my husband will receive his last treatment of Opdualag this upcoming coming week. We are very happy and relieved.
I miss understood what you needed so I’ll try again. Hopefully I’ll get it correct.
ANC Lymph AB
4/24 5.1 4/24 13.6
3/24 4.56 3/24 8.67
2/24 4.2 2/24 7.6
1/24 5.0 1/24 7.9
12/ 23 4.5. 12/23 7.9
Thank you for the graph and one other point you stated was since the tumor load in the nodes decreased that can cause a rise in the WBC. Could you please tell us a little more about that.
Linda, thanks for that additional data. So your husband's neutrophil count has remained stable around 5 and his lymphocyte count was also stable around 8, until his last lymphocyte count, where it increased by just under 5.0.
From the results I shared earlier, you can see that it's not unusual to have an occasional large increase, followed by a drop back. That's actually a statistical property termed "Regression to the Mean". So it's likely his next lymphocyte count will be lower.
With respect to CLL driven changes in the lymphocyte count and hence the WBC, the CLL tumour load distribution is influenced by signalling from CLL cells, which is in turn influenced by CLL cell receptors and pathways. Drugs which inhibit the B Cell Receptor pathway (BTK 'brutinib' and PI3K 'lisib' treatments), also inhibit the CLL signalling that keeps the cells anchored in their self created supportive microenvironments, where they proliferate. With this signalling inhibited, the CLL cells drift into the blood in a dormant phase, often causing a peak in the lymphocyte count and then eventually die, so that the lymphocyte count falls. One study has found that cannabinoids can cause the reverse effect, causing a drop in CLL cells as they migrate to nodes and marrow.
Neil you are so knowledgeable and supportive. Many thanks.
We were upset this morning when we first read the results but you helped us have a better understanding of results. We don’t see his hematologist until July, do you think he needs to see her sooner?
You husband has had stable, what looks to be low stage CLL for 3 years, hence the 6 monthly check-ups. Given he's going through a transition with the ending of treatment for his melanoma and you've had one higher than expected lymphocyte count result, there's some sense in arranging a blood test check before July, if only for peace of mind. Just keep in mind that your husband's lymphocyte count is low and while that's what we tend to concentrate on (or the less accurate WBC), what's most important with regards to his health, are trends in haemoglobin signalling the development of anaemia and likewise platelets/thrombocytopenia, plus any obviously enlarging nodes. There are other signs to watch for mentioned in the post I referenced earlier healthunlocked.com/cllsuppo...
So perhaps your husband can arrange an interim CBC/CBE/FBC blood panel test through his regular doctor (PCP) in a month or so and if there are any concerns arising from that blood test or any other signs that his CLL is becoming more active, then ask for an earlier appointment with his CLL haematologist.
Thank you Neil for all your help today, it is greatly appreciated. We will follow up with all the attached links you provided and your advice. I will keep you updated.
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