One month on brukinsa (Zanubrutinib) and my white blood count is still going up.

[Tajie]

Latest number was 133, up from 122 a week ago. My oncology PA says this is normal and it may continue to go up for another couple of months or more! Has anyone else gone this route and, if so, what is your experience?

[cajunjeff]

Hello Tajik, it is very normal for anyone starting on zanu, or any other btk med, to see their wbc rise at first. ZANU is likely chasing cancerous cll cells from your nodes into your bloodstream., raising your counts. The cells will die there and within a reasonably short period of time you should see your wbc counts fall into a normal range.

[Richard_TX]

My Dr. at MD Anderson said you'll get an initial increase as the Brukinsa begins to flush out all the white blood cells. When I started on Brukinsa last May 2023 I didn't see an increase in WBC because it was almost one month before they checked again. They did say the increase could last longer than a month so I'm sure your white blood count will begin to drop very soon. Below are my labs before and after Brukinsa;

7/26/2016; WBC: 13.6 / HGB: 14.6 / Platelets: 232 / ALC: 7.9

11/8/2017; WBC: 17 / HGB: 14.6 / Platelets: 232 / ALC: 7.9

11/3/2022; WBC: 105.4 / HGB: 13.2 / Platelets: 208 / ALC: 86.43

5/11/23; WBC: 201.8 / HGB: 12.9 / Platelets: 199 / ALC: 185.66

5/19/2023; Begin Brukinsa

6/13/23; WBC: 158.5 / HGB: 12.5 / Platelets: 193 / ALC: 153.75

9/12/23; WBC: 50.10 / HGB: 14.7 / Platelets: 273 / ALC: 42.08

11/3/23; WBC: 23.9 / HGB: 14.8 / Platelets: 273 / ALC: 18.88

7/23/24; WBC: 8.9 / HGB: 14.3 / Platelets: 215 / ALC: 3.52

I have had zero side effects with Brukinsa. Within the first two weeks I noticed Lymp nodes decreasing tremendously. Prior to treatment, my urine stream was weak, and after just 10 days of treatment it was back to normal. I take all 4 capsules (4x80mg) once daily, every morning with my breakfast. Brukinsa is a game changer for CLL.

[Tajie in reply to Richard_TX]

Thanks much for the reassurance!

[AussieNeil Partner Administrator]

Attached are plots of how the Absolute Lymphocyte Count (ALC) changed for patients on acalabrutinib, another BTKi drug with very similar profile to zanubrutinib. (It's the increase in lymphocytes in your blood that is the major contributor to your increased WBC.) As you can see and as others have shared, it's common for white blood cell counts to temporarily increase when you start on a BTKi, then eventually decrease. Some patients on acalabrutinib didn't see their ALC drop until 2 to 3 months after starting treatment.

Neil

There's considerable variation in how long ALC peaks after starting acalabrutinib.

[bkoffman CLL CURE Hero in reply to AussieNeil]

Recent data suggests that a prolonged increased lymphocyte count with Ibrutinib is associated with better outcomes. As long as the nodes are shrinking, be happy.

Brian Koffman

CMO CLLSociety.org

[DRM18]

Hi Tajie,

Mine jumped up (from 15000 to 90000) within 48 hours, then stayed high for around three months before finally lowering.

--Dave!

[DUKELAXDAD]

I started Brukinsa last August a year ago. My WBC was 221k when I started. After 2-3 weeks it was 348k. But then started to come down. Friday a week ago it was 7K. Works great! All other blood numbers are now Normal! Have faith! Good luck.

[Tajie in reply to DUKELAXDAD]

Thanks for the encouragement, I really appreciate it!

[DianeSH]

I have heard there is a 'clean out phase', removing the bad stuff from our bones

[TruthJunkie]

Yes, Tajie, that happened with me, too. No worries, the WBC should go down soon.