question about low wbc/neutropenia

[ktwmn]

Again I am reaching out to the collective experience of this great forum. On Monday, I restarted chemo (folfox + avastin) after being off the juice for two months. My white blood cell count is low, specifically neutrophils are at 1.4. Last year I had 15 txs of folfiri and avastin and had a neulasta injection after each one. I'm wondering if this has permanently trashed my immune system.

Any ideas?

[teacher49]

I've had experience with low blood counts also from adjuvant chemo that I had in 2012.

The counts that the ONC was most concerned with are:

Platelets - 150,000 is low end of normal range.....but if it dips to 100,000 they may give a chemo break

Absolute Neutrophil Count (ANC) - This is an overall composite that they watch for chemo go or no go. Low end of normal range is 1.5.

I have recent experience with this.....my DH was diagnosed with esophageal cancer in Dec. and is finishing treatment with chemo/rad. I had to take him to ER last Thurs. because of high temp of 103.3. IV fluids for 8 hrs brought down the fever/neutropenic fever. Called the ONC and again, he only looked at the ANC which was 2.1.

Hopefully your counts will come back up. Take care.

[ktwmn]

Thanks, Teacher49. My concern is that I was off chemo for 8 weeks getting scans and 2nd opinions so my counts should have bounced back by now, even though avastin has a much longer half life than 5FU, oxaliplatin or leucovorin. So naturally my mind goes to thoughts of treatment-related secondary cancers (I've had over 30 chemo txs and 25 neulasta injections). Of course I have been very stressed out with all the new appointments, much like the initial dx I've had trouble sleeping etc. which must have some effect on the immune system.Thanks for listening.

[CRguy]

Dealing with low to borderline blood values :
dose reductions, time interval increases, marrow stimulating medications ( WBCs, platelets and RBCs ), transfusions, time !

I never fully tanked at any time but was on the bottom levels for most of the chemo.
Once I quit FOLFOX total WBCs took a few months to get stable with lymphocytes being low for 2-3 years after radiation (my guess !)
platelets held out borderline Ok and recovered in a few months to mid normal, RBCs are still in the bottom half of normal and I am 5+ years out from last FOLFOX !

Talking points for the docs :
Any nutritional issues to be corrected ( iron / folates / B12 etc ) ?
Marrow biopsy to assess stem cell "activity" ?
Thyroid levels / issues ?

Just thinking out loud here and
Sending best wishes and POSI +++ Vibes your way
Cheers
CRguy

[ktwmn]

Hey, thanks CRGuy...Now is there a bloody poem in that lot?

Seriously, it is so helpful to get others' read on this. The onc staff did not seem too concerned.

[CRguy]

Of Course !!!

BUTT best I could do on short notice

when the platelets are low
chemo is No Go
and we wait 'cos
that's what we're best at !

Hurry and wait
at the starting gate
till the docs
and the nurses decide

stickem' here ?
stickem' there ?
why should WE care
we're just along for the ride !

[vilca11]

JM, my dear friend, this IS concerning... What did dr.S. say - "did not seem concerned" does not cut the mustard - did you question him what to expect with chemo continuation?
Read Immunoscore thread I posted - Lpas has a good post there about the immune system management. It looks to me that you need a good ND now to work with on the immune issues... Big Hug and much Love, will email after my 53d st mess is over. Vilca

[ktwmn]

Great poem, CR!!

Vilca, they said it was minimally low so they will just do neulasta again.

[mariane]

Yesterday I had labs which showed again low WBC count: 3.5 , low platelet 89 000 and low HGB 10.5. I received 5FU pump only. I did not get the chance to discuss these labs with my oncologist. They showed up unusually late - 30 minutes after my appointment with my Speedy Gonzales Dr. I wondered whether she skipped Irinotecan due to the numbers??? I had low numbers (almost the same level) before my last surgery in May. A week after surgery they went up to almost norm (except hemoglobin). Now they are down again My body seems to refuse more chemo what scares me....

My question is - what unconventional treatment if there is any that really boosts blood counts??? I know that I need time, rest, etc. I think protein help a bit, as well. I have 4 more months of chemo to go if everything goes well.

My last scan was clear, every visible cancer got resected and I had complete pathological response but cancer is so unpredictable and scares me. My CEA since November was 2.2, 2.0, 1.9, 2.0, 1.7, 1.9, 1.6, 1.9, 1.7, 1.9 at MSKCC. In Atlanta it was: 0.5, 1.0, 0.5, <0.5 before my last surgery. Every little fluctuation makes me think that will do chemo for life and my body will not take it

CR guy I love your song.

[AussieAssCancer]

I'm at a total loss re my bloods.

All through my neo-adjuvant t'ment, everything was perfect. Onc said there was no evidence that I was even having chemo.

First Rd of adjuvant t'ment smashed me due to dosage at previous weight, despite being 14kg lighter following surgery/ileostomy. As a result, liver function, RBC and WBC bottomed out but no enough to stop treatment/require neulasta(?) shot.

Neutrophils sit around 1.6-1.8 for next couple and then just before last Rd (disconnected today), after a week of being sick as a dog with a cold from my darling 2yo daughter, and a solid catch-up drinking session on the weekend (when I'd beaten the cold), my neutrophils jump back to 5.6 and liver, RBC are all normal again...

I give up and just turn up hoping to get stabbed/pumped

[mariane]

I'm at a total loss re my bloods.

All through my neo-adjuvant t'ment, everything was perfect. Onc said there was no evidence that I was even having chemo.

First Rd of adjuvant t'ment smashed me due to dosage at previous weight, despite being 14kg lighter following surgery/ileostomy. As a result, liver function, RBC and WBC bottomed out but no enough to stop treatment/require neulasta(?) shot.

Neutrophils sit around 1.6-1.8 for next couple and then just before last Rd (disconnected today), after a week of being sick as a dog with a cold from my darling 2yo daughter, and a solid catch-up drinking session on the weekend (when I'd beaten the cold), my neutrophils jump back to 5.6 and liver, RBC are all normal again...

I give up and just turn up hoping to get stabbed/pumped

Hi AussieAssCancer,
Our organisms are unpredictable. My kids also bring viruses. On April I got a bug from my daughter and I thought I would not get chemo. I ended up with FOLFIRI and FUDR - my last treatment before surgery. No excuses. Now I am getting adjuvant chemo just 5FU but it's not much easier for me than all the previous treatments.

Good Luck,