My husband is about 7 months out of transplant and doing well on 10 mg Revlimid maintenance 21 days on / 7 days off. He has never achieved complete response (CR) but also never had really bad numbers. His free light chain numbers are all normal and he currently has a 0.2 g/dl M-spike, down from 0.4 pre transplant. He does suffer from lower white counts but has no infections or respiratory issues. He feels fine other than some minor fatigue at the end of his cycle.
But lately we have noticed that his eosinophil (EOS) percentage has gotten higher -- going from 6% in September to 9% in October and now 16% in November. He has no rash or any other allergic feelings and doctors said they sometimes see this with Revlimid and aren't concerned. He never had this during induction but we are thinking his immune system is still regenerating.
Has this happened to anyone else? Is there a threshold where it becomes problematic?
Thanks.
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Nanjeanne - Name: Nanjeanne
- Who do you know with myeloma?: My Husband
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 66
Re: Rising eosinophil percentage on Revlimid maintenance
Hi Nanjeanne,
Are you able to check whether the absolute level of your husband's eosinophils is rising? I'm just wondering if perhaps the percentage is going up because some of his other cell counts might be going down, which could (I think?) elevate the eosinophil percentage without any actual increase in the eosinophil count.
Given how much the percentage has gone up, the absolute level probably is going up also. But it might not be going up as much as it seems from the change in the percent.
Also, I found this earlier discussion here in the forum that may help you some:
"High eosinophils on Revlimid maintenance" (started Nov 5, 2013)
I hope your husband keeps doing well on the Revlimid maintenance and that the eosinophil numbers don't turn out to mean anything important.
Are you able to check whether the absolute level of your husband's eosinophils is rising? I'm just wondering if perhaps the percentage is going up because some of his other cell counts might be going down, which could (I think?) elevate the eosinophil percentage without any actual increase in the eosinophil count.
Given how much the percentage has gone up, the absolute level probably is going up also. But it might not be going up as much as it seems from the change in the percent.
Also, I found this earlier discussion here in the forum that may help you some:
"High eosinophils on Revlimid maintenance" (started Nov 5, 2013)
I hope your husband keeps doing well on the Revlimid maintenance and that the eosinophil numbers don't turn out to mean anything important.
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JimNY
Re: Rising eosinophil percentage on Revlimid maintenance
Very interesting, JimNY. Thanks for this suggestion. I do remember at our last meeting with the doctor he did reference that the overall number actually wasn't bad, and then he said this was probably an allergic reaction to the Revlimid that didn't manifest itself in a rash. But we would watch it.
Googling information I found out how to calculate the absolute number. Based on this, if I understood how to calculate it properly, when his WBC was 2.7 and his eosinophil percent was 9%, that gave me 243. And his last blood count done was WBC 3.2 and eosinophil percent 16%, which gives 512. So he was within range except for this last reading (upper limit is 350).
Will definitely keep an eye on it and see what happens next month when we do blood again.
Thanks for this information!
Googling information I found out how to calculate the absolute number. Based on this, if I understood how to calculate it properly, when his WBC was 2.7 and his eosinophil percent was 9%, that gave me 243. And his last blood count done was WBC 3.2 and eosinophil percent 16%, which gives 512. So he was within range except for this last reading (upper limit is 350).
Will definitely keep an eye on it and see what happens next month when we do blood again.
Thanks for this information!
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Nanjeanne - Name: Nanjeanne
- Who do you know with myeloma?: My Husband
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 66
Re: Rising eosinophil percentage on Revlimid maintenance
Nanjeanne, Your postings are rather interesting and relevant for my own situation.I am particularly relieved to learn (finally) that a doctor has indicated that a rise in eosinophil levels is sometimes associated with Revlimid.
My own initial induction regimen consisted of Revlimid and dexamethasone. While I was on this regimen, both my absolute and percentage levels were considerably higher than your husband's. I worried about this, but was unable to get any explanation from my specialist. She did not seem to be concerned.
I started the Revlimid in August 2014 and by mid-October developed a severe, unexplained cough that persisted for over ten months. I came to believe that the rise in my eosinophil numbers was somehow connected to the cough. When I finally stopped taking Revlimid and dexamethasone, my eosinophil numbers returned to normal. My WBC for the last few months appear to be within normal range but this month, for the very first time, the Eos absolute value is slightly below normal. I had overlooked this result earlier. But for your posting,, I probably would not have even noticed.
Both my Eos numbers and my cough disappeared when I stopped the Revlimid so I think this gives credence to your doctor's suggestion that this medication is probably the source of the problem. It certainly explains things for me, so many thanks.
My own initial induction regimen consisted of Revlimid and dexamethasone. While I was on this regimen, both my absolute and percentage levels were considerably higher than your husband's. I worried about this, but was unable to get any explanation from my specialist. She did not seem to be concerned.
I started the Revlimid in August 2014 and by mid-October developed a severe, unexplained cough that persisted for over ten months. I came to believe that the rise in my eosinophil numbers was somehow connected to the cough. When I finally stopped taking Revlimid and dexamethasone, my eosinophil numbers returned to normal. My WBC for the last few months appear to be within normal range but this month, for the very first time, the Eos absolute value is slightly below normal. I had overlooked this result earlier. But for your posting,, I probably would not have even noticed.
Both my Eos numbers and my cough disappeared when I stopped the Revlimid so I think this gives credence to your doctor's suggestion that this medication is probably the source of the problem. It certainly explains things for me, so many thanks.
Re: Rising eosinophil percentage on Revlimid maintenance
Interesting mrozdav. It's quite possible the cough was some manifestation of this allergic reaction, although why it lasted for many months after you stopped taking Revlimid is odd.
When we first noticed the high eosinophil percentage we were at the 6 month post stem cell transplant checkup at Dana Farber and our doctor didn't mention it at all when we reviewed the numbers. When we pointed it out (the percent was 12.5 there), the actual number was 0.34 K/ul (within range) and Dr. Anderson said not to worry, they saw this with other patients on Revlimid.
When we did the last test at Yale where my husband is treated and saw it was 16% (up from 9% previous month), that seemed like a big jump. But, again, our doctor there didn't seem concerned. He asked if my husband had any rash, any cough, or other allergy-type feeling. When he said no, the doctor said the same as Dr. Anderson, that it was probably some minor allergic reaction that wasn't manifesting itself overtly and just to keep an eye on it.
We are leaving in a couple of weeks for an 8-day trip to Rome and both doctors said for my husband to skip the Revlimid while we are gone. Since we leave right after his week off, he will actually be off Revlimid for 2 weeks. So it will be interesting to see what his eosinophil count is when we return. He is scheduled to have his complete blood work done a few days after we get back.
When we first noticed the high eosinophil percentage we were at the 6 month post stem cell transplant checkup at Dana Farber and our doctor didn't mention it at all when we reviewed the numbers. When we pointed it out (the percent was 12.5 there), the actual number was 0.34 K/ul (within range) and Dr. Anderson said not to worry, they saw this with other patients on Revlimid.
When we did the last test at Yale where my husband is treated and saw it was 16% (up from 9% previous month), that seemed like a big jump. But, again, our doctor there didn't seem concerned. He asked if my husband had any rash, any cough, or other allergy-type feeling. When he said no, the doctor said the same as Dr. Anderson, that it was probably some minor allergic reaction that wasn't manifesting itself overtly and just to keep an eye on it.
We are leaving in a couple of weeks for an 8-day trip to Rome and both doctors said for my husband to skip the Revlimid while we are gone. Since we leave right after his week off, he will actually be off Revlimid for 2 weeks. So it will be interesting to see what his eosinophil count is when we return. He is scheduled to have his complete blood work done a few days after we get back.
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Nanjeanne - Name: Nanjeanne
- Who do you know with myeloma?: My Husband
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 66
Re: Rising eosinophil percentage on Revlimid maintenance
I remember your postings about your cough while you were on Revlimid, Mrozdav. However, I don't remember you mentioning anything about your eosinophil levels being elevated.
That got me wondering, and I checked, and there is actually a version of bronchitis called – are you ready? – "eosinophilic bronchitis".
These articles have some more information:
CE Brightling et al, "Eosinophilic Bronchitis Is an Important Cause of Chronic Cough", American Journal of Respiratory and Critical Care Medicine, 1999 (full text of article)
CE Brightling, "Chronic cough due to nonasthmatic eosinophilic bronchitis: ACCP evidence-based clinical practice guidelines," Chest, 2006 (full text of article)
I haven't read the article enough to determine if elevated eosinophils from Revlimid can lead to this "eosinophilic bronchitis". Perhaps you can do some more digging and let us know what you find.
That got me wondering, and I checked, and there is actually a version of bronchitis called – are you ready? – "eosinophilic bronchitis".
These articles have some more information:
CE Brightling et al, "Eosinophilic Bronchitis Is an Important Cause of Chronic Cough", American Journal of Respiratory and Critical Care Medicine, 1999 (full text of article)
CE Brightling, "Chronic cough due to nonasthmatic eosinophilic bronchitis: ACCP evidence-based clinical practice guidelines," Chest, 2006 (full text of article)
I haven't read the article enough to determine if elevated eosinophils from Revlimid can lead to this "eosinophilic bronchitis". Perhaps you can do some more digging and let us know what you find.
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JimNY
Re: Rising eosinophil percentage on Revlimid maintenance
JimNY,
I was aware of this type of bronchitis and brought it to my doctors' attention, but they all said that I did not have it. The last doctor I saw was an allergist. To him I brought in a list of my absolute eosinophil numbers, but this was not helpful because he said he needed to see the percentages. At this time, however, I had just gone off Revlimid, my cough was dramatically subsiding, and he concluded that the source of my problem was the Revlimid. I subsequently forgot about the eosinophils until reading Nanjeanne's postings this evening.
I was aware of this type of bronchitis and brought it to my doctors' attention, but they all said that I did not have it. The last doctor I saw was an allergist. To him I brought in a list of my absolute eosinophil numbers, but this was not helpful because he said he needed to see the percentages. At this time, however, I had just gone off Revlimid, my cough was dramatically subsiding, and he concluded that the source of my problem was the Revlimid. I subsequently forgot about the eosinophils until reading Nanjeanne's postings this evening.
Re: Rising eosinophil percentage on Revlimid maintenance
Just an update on this - because we were traveling to Italy, our doctor suggested that my husband not take Revlimid for the 8 days we were going to be gone. The week before our departure was his off week from the 21/7 cycle. Once we returned, he had his blood drawn a few days later - so, in essence was off Revlimid for about 18 days. Typically in the one week off, his numbers don't come up significantly. However, after 18 days off - not only was his WBC, Hgb and Hct up in the normal range - but the Eosophils percentage dropped to 2%.
So we are pretty sure that, as the doctors suggested, the rising Eos was due to a slight allergic reaction to the Revlimid -- and according to them, something they see with others and nothing to worry about. Good to know if anyone else is experiencing this.
So we are pretty sure that, as the doctors suggested, the rising Eos was due to a slight allergic reaction to the Revlimid -- and according to them, something they see with others and nothing to worry about. Good to know if anyone else is experiencing this.
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Nanjeanne - Name: Nanjeanne
- Who do you know with myeloma?: My Husband
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 66
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