Wbc count 425000

[Sss1612]

My father aged 69 having cll nhl who is diagnosed 13 years back. He had multiple cycles of chemo with bentasmine and ritixmab. The last chemo was taken before 3 months only with bentasmine . While checking the wbc count last week it is 425000 and hemoglobin level is 6 with platlets 80000..doctor advised to take imburvica however we are not able to manage the cost and no insurance ..pls advise what to do now..we are in India..

Can we request doctor to to another round of chemo with rituxmab ? Or pls suggest any advise . His health is ok but having fatigue

If only one tablet of imburvica taken per day, we somehow try to manage the cost

[AussieNeil Administrator]

Sorry to hear of your father's situation. We have a few members from India, where CLL expertise is hard to come by (with CLL being much more rare than in Western countries) and treatment costs (with newer drugs in particular), challenging.

With regard to your father's blood counts, the only one of real concern is his low haemoglobin. CLL cells are small and rarely cause complications, with the highest count I know of being 1,000,000 higher than your father's. That said, I suspect your father's doctor might also prescribe allopurinol to protect against Tumour Lysis Syndrome, which can occur if treatment kills off CLL cells faster than the body can deal with the dying cells. If your father's haemoglobin drops further, he may temporarily need blood transfusions. Platelet transfusions are generally not required until counts drop below 10 to 20,000.

With respect to repeating Rituximab, how well it works will depend on how much CD-20 his CLL cells express, as repeated applications of Rituximab can reduce that expression and make Rituximab less effective.

How well patients respond on lower doses of Ibrutinib is still being studied. If your father has low body weight, he may be able to do well on one tablet per day, but I think his doctor would want to see his lymphocyte count much lower first.

I'm not medically trained, so you need to discuss the above with your father's doctor.

Neil

[Sss1612 in reply to AussieNeil]

Thanks for the reply. His current weight is 50 KG. Doctor advised 1 unit (approx 500 ml) of blood transfusions . He undergone one more round of RCHOP two days before. Need to take blood test and share with doctor for further advise in next week. Will discuss with doctor for 1 tablet considering his weight

[attarintiki]

I am also from India but living in Europe

From which city are you from ? If you are in Bangalore I can suggest you the name of an excellent expert with wast experience whom I consult from time to time. Wishing father a speedy recovery

[Sss1612 in reply to attarintiki]

Thanks for the reply.. We are based on Chennai.

[attarintiki in reply to Sss1612]

As you are in Chennai (south) if you want you can consult Dr. A. Satish Kumar Haemato Oncologist at Columbia Asia Hospital Yeshwantpur Bangalore for a second opinion and advise for your father.