Increase in ALC/WBC

[AAli]

Any one can guide on ALC doubling and its impact? Also if ALC/WBC is above 1 lac and increase by 15% in 04 months, what the trend shows?

Regards

[Myrddin]

The absolute level of the ALC is not as important as the rate of change and other symptoms like enlarged lymph nodes and spleen. Alc doubling in 6 months is a criteria used by doctors to consider treatment.

[AussieNeil Administrator]

Aali, I'm not sure what you mean when you say "Also if ALC/WBC is above 1 lac"?

Doubling time for ALC is only used as a criterion for treatment if the starting ALC averages above 30. A doubling time in under 6 months is a strong indicator for starting treatment and doubling in under a year is also a warning sign that treatment may be imminent.

IF the 15% increase over 4 months continues, your ALC in a year's time works out at a 45% increase over the year, which would not be a concern. There's no certainty that that rate of increase would continue either.

From Management of chronic lymphocytic leukemia, Paolo Ghia, and Michael Hallek:

haematologica.org/content/9...

"In short, treatment should be applied in the presence of cytopenias (anemia and/or thrombocytopenia) due to bone marrow failure, or if bulky (>10 cm) or rapidly progressing lymphadenopathy occurs, or if a rapid increase (doubling within 6 months) of the lymphocyte counts or severe constitutional symptoms (night sweats,

fever, weight loss, fatigue) occur.

A few comments might help to interpret these recommendations. First, it should be pointed out that the absolute lymphocyte count is not a criterion for initiation of treatment. Lymphocyte counts of even a few hundred thousand lymphocytes per μL cause no harm, and both patients and doctors should be reassured at this point. LDT should be evaluated only if the level of lymphocytes is above 30x10 9 /L, because values may fluctuate at lower levels with no clinical significance. Moreover, it is important to remember that LDT is rarely an indication to initiate treatment. An isolated, rapid rise in lymphocyte count without any other symptom rarely occurs, and other reasons should be excluded (e.g. use of corticosteroids for unrelated causes). Similarly, severe constitutional symptoms are rarely the only criterion to start therapy and are often associated with other signs of the disease (cytopenia, lymphadenopathy)." (my emphasis)

PLEASE, stop worrying!

Neil

[PeterMasih in reply to AussieNeil]

Hi Neil.

Even in English, in the sub-continent the Urdu/Sanskrit numbering system is the default for higher numbers. These are:

Lac (often spelt Lakh) = 100,000 [or in subcontinental notation 1,00,000]

Krore = 10,000,000 [or 1,00,00,000]

The word million is used only rarely.

[AussieNeil Administrator in reply to PeterMasih]

Thanks Peter,

So answering AAli's question using 1 lac = 100,000, where the normal range ALC is 1,000 to 3,500. (Incidentally, these are in units most often used in the USA. Elsewhere the equivalent units would be considering an ALC over 100 with a normal ALC range of 1.0 to 3.5.)

Starting from an ALC of 1 lac, an increase of 15% in 4 months if it continues at the same rate, still only rises to 1.45 lac after 12 months. It would need to grow to 2 lac in 6 months before treatment was considered. But then we still have to bear in mind Dr Hallek's statement (see above), Moreover, it is important to remember that LDT is rarely an indication to initiate treatment.

So there's absolutely no reason to be concerned that treatment will be required any time soon based on a 15% change in an ALC above 1 lac over a period of 4 months.

Neil