Hello,
I just started on Velcade and dexamethasone and prior to treatment I had low white blood cell (WBC) counts and low neutrophils. After my first treatment, my neutrophils went up, but I have very, very low, or no, other white blood cells..
Neutrophils 94.4 %
Lymphocytes 4.8 %
Monocytes 0.6 %
Eosinophils 0.0 %
Basophils 0.0 %
Immature Grans 0.1 %
ABS Neutrophils 6.66 (2.20 - 8.85 K/cmm)
ABS Lymphs 0.34 L (1.09 - 3.30 K/cmm)
ABS Monocytes 0.04 L (0.1 - 0.8 K/cmm)
ABS Eosinophils 0.00 L (0.03 - 0.61 K/cmm)
ABS Basophils 0.00 L (0.01 - 0.11 K/cmm)
ABS Immature Grans 0.01 (0 - 0.06 K/cmm)
Is this typical after a single dose of therapy?
Thanks,
J
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jhorner - Name: Magpie
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 2013
- Age at diagnosis: 49
Re: Very low white cell counts on Velcade & dexamethasone
Hi J,
I don't know "typical," and I don't know doublet therapy, but my husband has had profound lymphopenia (low lymphocytes) throughout his myeloma treatment – in his case with Kyprolis, Revlimid, and dexamethasone (KRD).
Myeloma cells are plasma cells, which are in turn a type of lymphocyte. So we've assumed this was a marker of the effectiveness of the treatment. He is minimal residual disease (MRD) negative and is on maintenance now and still lymphopenic (his absolute lymphocyte count is about twice your current number, but hasn't broken 0.8 in almost a year except in the post-transplant honeymoon period). His other cell lines have all recovered. To me, it looks like you are likely having a robust response, perhaps aggravated by where your starting numbers were.
We take precautions to avoid viral illnesses. He is on acyclovir and weekend Septra (Bactrim, sulfamethoxazole and trimethoprim) also.
Wishing you well.
I don't know "typical," and I don't know doublet therapy, but my husband has had profound lymphopenia (low lymphocytes) throughout his myeloma treatment – in his case with Kyprolis, Revlimid, and dexamethasone (KRD).
Myeloma cells are plasma cells, which are in turn a type of lymphocyte. So we've assumed this was a marker of the effectiveness of the treatment. He is minimal residual disease (MRD) negative and is on maintenance now and still lymphopenic (his absolute lymphocyte count is about twice your current number, but hasn't broken 0.8 in almost a year except in the post-transplant honeymoon period). His other cell lines have all recovered. To me, it looks like you are likely having a robust response, perhaps aggravated by where your starting numbers were.
We take precautions to avoid viral illnesses. He is on acyclovir and weekend Septra (Bactrim, sulfamethoxazole and trimethoprim) also.
Wishing you well.
-
rick - Name: rick
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: nov 2015
- Age at diagnosis: 50
Re: Very low white cell counts on Velcade & dexamethasone
Hi J,
I'm new to the subject of lymphocytes, so can only add my data. Here are the results of my latest CBC, at end of first cycle and halfway through my 2nd cycle of Revlimid, Velcade, and dexamethasone (RVD):
Test End of 1st 1/2 of 2nd
May 31 Jun 13
2017 2017
WBC Count 12.9 9.10 3.8-10.6 K/uL
RBC Count 4.35 4.52 4.40-6.00 M/uL
Hemoglobin 13.7 14.3 13.5-17.0 g/dL
Hematocrit 40.2 41.6 41-53 %
MCV 92.1 80-100 fl
MCH 31.7 26-34 pg
MCHC 34.4 31-37 g/dL
RDW 14.5 14.6 H <14.5 %
Platelet Count 164 235 150-450 K/uL
Neutrophils 76 75 %
Lymphocytes 9 8 %
Monocytes 11 1 %
Eosinophils 4 1 %
Basophils 0 0 %
ABS Neutrophils 9.70 6.83 2.20-8.85 K/cmm)
ABS Lymphs 1.20 0.73 L 1.09-3.30 K/cmm)
ABS Monocytes 1.40 0.09 L 0.1-0.8 K/cmm)
ABS Eosinophils 0.60 0.09 L 0.03-0.61 K/cmm)
ABS Basophils 0.00 0.00 L 0.01-0.11 K/cmm)
Band % 9 %
Metamyelocytes % 4 %
Myelocytes % 2 %
Band, abs 0.82 H 0.00-0.80 K/uL
Metamyelocytes, abs 0.36 H 0.00 K/uL
Myelocytes, abs 0.18 H 0.00 K/uL
Platelet Estimate Adequate
So, quite a drop in ABS Lymphocytes Monocytes and Eosinophils. However WBC and Neutophils moved into the normal range.
Some Internet searching yielded:
Neutrophils are white blood cells that play some very important roles in our innate immune system. They circulate around our body in the bloodstream, and when they sense signals that an infection is present, they are the first cells to migrate to the site of the infection to begin killing the invading microbes.
Lymphocytes are white cells that are crucial to our immune systems. There are three main types known as T cells, B cells, and natural killer cells. Lymphocytes are part of our immune defense and act to recognize antigens, produce antibodies, and destroy cells that could cause damage.
Monocytes are a type of white blood cell that fights off bacteria, viruses and fungi. Monocytes are the biggest type of white blood cell in the immune system. Originally formed in the bone marrow, they are released into our blood and tissues.
The functions of the eosinophil are varied, some of which are very similar to other white blood cells. They are implicated in numerous inflammatory processes, especially allergic disorders. In addition, eosinophils may have a physiological role in organ formation (e. g. post-gestational mammary gland development).
Basophils appear in many specific kinds of inflammatory reactions, particularly those that cause allergic symptoms. Basophils contain anticoagulant heparin, which prevents blood from clotting too quickly. They also contain the vasodilator histamine, which promotes blood flow to tissues.
It's the first time I have seen Myelocytes on my result panel, Here is their description:
A myelocyte is a young cell of the granulocytic series, occurring normally in bone marrow (can be found in circulating blood when caused by certain diseases).
A couple of links on lymphocytopenia:
http://www.merckmanuals.com/home/blood-disorders/white-blood-cell-disorders/lymphocytopenia
http://www.betterhealthtips.org/low-lymphocytes/
My take on low lymphocytes is that it is a known consequence of multiple myeloma treatment, affecting some more than others. We are warned that our immune systems will be compromised during treatment. If it gets too bad, I would expect the doctor may adjust multiple myeloma treatment dosage.
Is anyone familiar with at what level it becomes a problem?
Tony
I'm new to the subject of lymphocytes, so can only add my data. Here are the results of my latest CBC, at end of first cycle and halfway through my 2nd cycle of Revlimid, Velcade, and dexamethasone (RVD):
Test End of 1st 1/2 of 2nd
May 31 Jun 13
2017 2017
WBC Count 12.9 9.10 3.8-10.6 K/uL
RBC Count 4.35 4.52 4.40-6.00 M/uL
Hemoglobin 13.7 14.3 13.5-17.0 g/dL
Hematocrit 40.2 41.6 41-53 %
MCV 92.1 80-100 fl
MCH 31.7 26-34 pg
MCHC 34.4 31-37 g/dL
RDW 14.5 14.6 H <14.5 %
Platelet Count 164 235 150-450 K/uL
Neutrophils 76 75 %
Lymphocytes 9 8 %
Monocytes 11 1 %
Eosinophils 4 1 %
Basophils 0 0 %
ABS Neutrophils 9.70 6.83 2.20-8.85 K/cmm)
ABS Lymphs 1.20 0.73 L 1.09-3.30 K/cmm)
ABS Monocytes 1.40 0.09 L 0.1-0.8 K/cmm)
ABS Eosinophils 0.60 0.09 L 0.03-0.61 K/cmm)
ABS Basophils 0.00 0.00 L 0.01-0.11 K/cmm)
Band % 9 %
Metamyelocytes % 4 %
Myelocytes % 2 %
Band, abs 0.82 H 0.00-0.80 K/uL
Metamyelocytes, abs 0.36 H 0.00 K/uL
Myelocytes, abs 0.18 H 0.00 K/uL
Platelet Estimate Adequate
So, quite a drop in ABS Lymphocytes Monocytes and Eosinophils. However WBC and Neutophils moved into the normal range.
Some Internet searching yielded:
Neutrophils are white blood cells that play some very important roles in our innate immune system. They circulate around our body in the bloodstream, and when they sense signals that an infection is present, they are the first cells to migrate to the site of the infection to begin killing the invading microbes.
Lymphocytes are white cells that are crucial to our immune systems. There are three main types known as T cells, B cells, and natural killer cells. Lymphocytes are part of our immune defense and act to recognize antigens, produce antibodies, and destroy cells that could cause damage.
Monocytes are a type of white blood cell that fights off bacteria, viruses and fungi. Monocytes are the biggest type of white blood cell in the immune system. Originally formed in the bone marrow, they are released into our blood and tissues.
The functions of the eosinophil are varied, some of which are very similar to other white blood cells. They are implicated in numerous inflammatory processes, especially allergic disorders. In addition, eosinophils may have a physiological role in organ formation (e. g. post-gestational mammary gland development).
Basophils appear in many specific kinds of inflammatory reactions, particularly those that cause allergic symptoms. Basophils contain anticoagulant heparin, which prevents blood from clotting too quickly. They also contain the vasodilator histamine, which promotes blood flow to tissues.
It's the first time I have seen Myelocytes on my result panel, Here is their description:
A myelocyte is a young cell of the granulocytic series, occurring normally in bone marrow (can be found in circulating blood when caused by certain diseases).
A couple of links on lymphocytopenia:
http://www.merckmanuals.com/home/blood-disorders/white-blood-cell-disorders/lymphocytopenia
http://www.betterhealthtips.org/low-lymphocytes/
My take on low lymphocytes is that it is a known consequence of multiple myeloma treatment, affecting some more than others. We are warned that our immune systems will be compromised during treatment. If it gets too bad, I would expect the doctor may adjust multiple myeloma treatment dosage.
Is anyone familiar with at what level it becomes a problem?
Tony
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Tony Y - Name: Tony Y
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: April 2017
- Age at diagnosis: 49
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