The Colon Club

Hi there!

My last chemo was in early December. (Officially I'm on a chemo break - unofficially I'm ready for it to last forever.) : )

BUT today when I went in for my pump fill, they flagged me for low ANC - normal range starts at 1.5, and I was at 1.0 today.

Three weeks ago it was 1.3; three weeks before that it was 1.5. Basically it has been trending down by .2 or .3 every few weeks ever since I stopped chemo. Now it is so low that my Covid vaccine (scheduled next Thursday) is in danger!

The nurse practioner thought maybe my body had grown overly reliant on Neulasta, but I haven't had a shot of that since this summer, when we discontinued Irinotecan - so it seems like that would be quite a lag effect. In Googling, I saw a reference to RA - which I thought I might have after some positive screeners a year ago, but which we now think may have actually been paraneoplastic response. We pulled my CEA again today to see if any change - it has remained stable at ~1.1 for my last 3-4 tests, all 3-6 weeks apart.

Has anyone experienced anything similar or have any thoughts on what might be happening?

I can't remember exactly what I was told. But was told after chemo to have regular bone density tests and watch wbc and/or anc. Chemo can do damage to bone or bone marrow. I also had radiation so that may play in also why it was recommended.

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.

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.

Thanks so much for sharing this - it was super helpful to understand some of the science related to the vaccine, etc. And even just the fact that this is mild and I should still be able to mount a response.

To be honest, i think i'm more worried about what my declining WBC means for my CANCER than for my VACCINE! It has actually been steadily declining since November - so it's more like 5-6 drops in succession, and it's never been as low as it is now. However, that could certainly be from the chemo. I know after my third surgery, my red blood count struggled for months to get back to normal levels.

They will pull labs again on Monday - fingers crossed it will start to look better!