White count increased after starting Brukinsa

[Tajie]

I began initial treatment for CLL only 5 days ago and, in that time, my white blood count went up quite a bit. Has anyone else had this happen? My oncologist is not concerned saying that sometimes happens for the first three or four weeks but I would like confirmation from someone else who has experienced this effect.

[DriedSeaweed]

What is happening is that your lymph nodes are getting the CLL flushed out of them and into the blood stream. This is a “good thing” since the cells are more likely to die being denied access to the lymph nodes. Many of us in the span of a week go from looking like a chipmunk full of nuts to a normal human being.

If you lock your post you may get more responses.

[DRM18]

Absolutely normal, expected, honestly a very good sign.

Might take a bit for them to peak, then slowly (weeks to months) the ALC will approach normality.

[Cdub32]

I am experiencing the same..on Brukinsa for one week..my WBC increased by 130k..oncologist says OK..I was freaking out..all those little bad guys are now out in the blood stream. Followup in 2 weeks..

[Nana1961 in reply to Cdub32]

hi,

I started Zanu 3 weeks ago. My wbc went from 55k to 218k. Doc said it’s expected and will come down.

[Billy_Oz in reply to Nana1961]

Yes, I started Ibrutinib just over a week ago and my count went from 70 to 185. Not sure how high it will go when I add in Venetoclax in 3 months.

[AussieNeil Partner Administrator]

As others have shared, this commonly occurs with BTKi treatments. I've attached plots for several people on Calquence acalabrutinib, a very similar drug to Brukinsa/zanubrutinib.

Please monitor your absolute lymphocyte and absolute neutrophil counts, not your WBC. You want your lymphocyte count to eventually fall but if your neutrophil count also falls and goes below 1.5 (or more usually 1,500 in the USA - different scale), your risk of infection increases.

Neil

About 2/3 of the time, the lymophocyte count initially increases with BTKi treatments.

[Tajie]

Thanks to all who replied to my concern! You have reassured me and I will continue my weekly oncology visits with renewed confidence.

[Schubert1870]

This is exactly what my recent blood count showed after one week on the trial drug. Because I went through the same experience on a previous treatment a few years ago, I knew it was a positive sign. It’s truly amazing how fast these different drugs work!

[IRN83]

I too am on Brukinsa. I started it 2.5 months ago. Mine did exactly the same thing and hasn’t decreased yet. It is expected that the white blood count will increase for a couple of months after starting B. Best wishes!

[Eedew]

Totally normal. The cancer cells are dying off and being released into blood

[DUKELAXDAD]

when I started Brukinsa my white count went up from 221k to 348k pretty quickly. Also more importantly my Neutrophils when pretty quickly to zero. But within a month the WBC started to go down, and my neutrophils came up. 11 months into treatment all my numbers are in the normal range. Good luck!

[Tajie in reply to DUKELAXDAD]

Thanks!

[skipro]

While I have not taken this drug, I've had multiple treatments for CLL

My CLL specialist told me if I were to take the drug you are on to expect w

my wbc to increase for a while as the wbc's exit spleen and other organs

Good luck and God bless

[CoachVera55]

Yes in exactly 5 days I had a large hematoma so I got bloods drawn; Hgb 10.8->10, Plts 76->108 & WBC 81->118. My mouth was sore & my feet were burning 🔥

[SERVrider]

Shortly after I started on Acalabrutinib, my GP (house doctor) but you may call them something else in the US, took my annual diabetes blood draw and telephoned me with a concern (I won't say panic) because my ALC had rocketed up. When I told him that the consultant haematoloist/oncologist had started me on a BTK inhibitor he breathed an audible sigh of relief. So, it is perfectly normal.

[Tajie]

This is an update from Tajie. Thanks much to all who replied and reassured me that rising white count is normal at first. Yesterday I went back to my oncologist and my white blood count went up from 117 to 123. I am not concerned and will keep posting my weekly numbers in case anyone else finds them of interest/help.

[SofiaDeo in reply to Tajie]

It's not overall white count that being looked at, mostly certain subsets. If your lymphocytes went up with a corresponding decrease in neutrophils, your total white count could be the same, even if neutrophils were dangerously low. Lymphocytes and neutrophils are the ones most commonly monitored. And it's the lymphocyte count that commonly goes up after starting a BTK.

[Tajie in reply to SofiaDeo]

I did not ask my oncologist about those details but the fact that she was pleased with the blood test results encourages me to think my levels are ok.

[SofiaDeo in reply to Tajie]

I understand, docs may simply say "white cells" to laypeople. Even if you don't have a Patient Portal to view your results, you can ask for a copy to see the numbers yourself.

There is a saying in medicine, that informed patients overall have better care. Knowing a bit of the medical terminology may be helpful, say, if you were vacationing somewhere and had a problem. Ability to be succinct with medical terms relevant to you, may one day be helpful. The CLL Society in the US (CLLSociety.org) has a number of informational posts. The Pinned Posts section here has quite a few. If you prefer video, the Patient Power series (PatientPower.info) has a bunch.

[Tajie in reply to SofiaDeo]

Just checked the patient portal and my neutrophils are fine.