roadrunner wrote:This must be frustrating. Unfortunately I don’t have any bright ideas, but I will offer one observation. The decreases in ANC certainly *appear* to suggest a trend, but they are relatively small changes overall, and there are few data points (I think you mention two downward moves). You’re also relatively close to the end of chemo (as you likely know, 3 months is often used as the “recovery time” for the immune system from chemo, but recent studies in the breast cancer context (so different agents than we get) show at least a 9 month impact). Additionally, choice of lab, relative blood volume, and systemic considerations unrelated to cancer can cause variations in the test results. And your numbers aren’t high grade neutropenia. When I was at those levels during COVID, I asked about whether I could mount a robust response if I got it, and my team said yes to that. There are billions of cells in play. So—overall —perhaps this is just “noise” and it will rebound?
For what it’s worth, I think the lymphocyte numbers are most relevant to the vaccine, or at least its likely efficacy. Perhaps they have a rule about ANC counts and vaccines due to the risk of bacterial infection. But it should I think be reassuring that the mRNA vaccines produce such robust responses that it appears likely that they will have decent efficacy even in immune challenged patients, and especially with respect to severe outcomes. I would suggest that you discuss the optimal time and blood counts for the shots with your team, though (if you haven't). Though the real world data (all health levels) is reassuring, these vaccines haven’t been tested in people like us, and we all want optimal coverage.
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