Six months after discovering he had multiple myeloma, my father went in to hospital last Saturday to have his high dose chemotherapy and autologous stem cell transplant.
His own stem cells were reinjected on Sunday morning, and the expectation was that over the course of the week his white blood cells would continue to drop. Once they get below 1.0, the hospital would move him into the full isolation ward until his stem cells had enough time to take and to start to generate new white blood cells.
Over the course of last week his white blood cell count dropped daily until it was at 1.2 yesterday. Then today it increased to 1.9.
This means it never actually dropped to zero, so he will not have to go into isolation, or have all the side effects of getting infections etc. His white blood count is increasing now, so it seems the transplanted cells are producing white blood cells faster than the old ones are dying off.
At first sight this sounds like a good thing. But could it mean the initial chemo treatment didn't do it's job at killing off all the existing bone marrow?
Just wondering if anyone else has heard of this happening?
(BTW - My father is late 60's, and healthy and fit. Treatment is in the UK)
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dominoman - Name: Mike
- Who do you know with myeloma?: Father
- When were you/they diagnosed?: 2014
- Age at diagnosis: 66
Re: White blood cell count higher than expected after SCT
Hi Dominoman,
The circulating white blood cells in your father's blood could have been there all along, since white blood cells live for 3 - 4 days or more. So your circulating blood after the high dose malphalan does still contain blood cells (thankfully). After the stem cell transplant, your marrow will start to produce more cells as the reinfused hematapoietic stem cells start to multiply.
When I had my ASCT, my neutrophils got down as low as 1.0, as I recall. If they had fallen lower than that, I would have needed to get blood transfusions, but I didn't need those. We were very careful about 'isolation', though, and I really hibernated at home for awhile until my counts came back up.
Hopefully, that is all that is happening here. Circulating blood cells already there and now regrowth from the marrow of new cells. But of course, check with the oncologist!!
The circulating white blood cells in your father's blood could have been there all along, since white blood cells live for 3 - 4 days or more. So your circulating blood after the high dose malphalan does still contain blood cells (thankfully). After the stem cell transplant, your marrow will start to produce more cells as the reinfused hematapoietic stem cells start to multiply.
When I had my ASCT, my neutrophils got down as low as 1.0, as I recall. If they had fallen lower than that, I would have needed to get blood transfusions, but I didn't need those. We were very careful about 'isolation', though, and I really hibernated at home for awhile until my counts came back up.
Hopefully, that is all that is happening here. Circulating blood cells already there and now regrowth from the marrow of new cells. But of course, check with the oncologist!!
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: White blood cell count higher than expected after SCT
Thanks Nancy.
We'd been told that the white blood cells would eventually hit zero (therefore the need for full isolation) before starting to slowly recover over the coming weeks.
In your case it sounds like the neutrophils also didn't get as low as that?
My father's consultant has just now told him that the increase today in the neutrophils level is an anomaly and that it will start to decrease again until it gets to zero. Sounds unusual that they would fluctuate to me. I'd have thought that, once the neutrophils die, they would be gone until the marrow produces new ones.
We'd been told that the white blood cells would eventually hit zero (therefore the need for full isolation) before starting to slowly recover over the coming weeks.
In your case it sounds like the neutrophils also didn't get as low as that?
My father's consultant has just now told him that the increase today in the neutrophils level is an anomaly and that it will start to decrease again until it gets to zero. Sounds unusual that they would fluctuate to me. I'd have thought that, once the neutrophils die, they would be gone until the marrow produces new ones.
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dominoman - Name: Mike
- Who do you know with myeloma?: Father
- When were you/they diagnosed?: 2014
- Age at diagnosis: 66
Re: White blood cell count higher than expected after SCT
Thanks Dominoman. I am not a doctor, but have tried to learn about myeloma as I have gone along. Maybe we are talking about a differing measurement system here. I am in Canada.
Hope your Dad does well with all of this. I know the blood counts can jump around a bit. I was just grateful actually not to get any sicker than I already was, to the point of needing transfusions!
I think that it's difficult to know whether or not a transplant 'worked' if one already had low levels of myeloma protein going into the process. My transplant doctor did tell us that it would get me a longer remission than would be the case just with the 'induction chemo'. That did prove out in my case, but I know it doesn't always, unfortunately. And of course in the last five years a lot of advances have been accomplished in the treatment of myeloma, and we have that to look forward to also.
Hope your Dad does well with all of this. I know the blood counts can jump around a bit. I was just grateful actually not to get any sicker than I already was, to the point of needing transfusions!
I think that it's difficult to know whether or not a transplant 'worked' if one already had low levels of myeloma protein going into the process. My transplant doctor did tell us that it would get me a longer remission than would be the case just with the 'induction chemo'. That did prove out in my case, but I know it doesn't always, unfortunately. And of course in the last five years a lot of advances have been accomplished in the treatment of myeloma, and we have that to look forward to also.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: White blood cell count higher than expected after SCT
Ideally the grafting starts prior to any need for transfusions, although that is not always the case. I was told that I would likely need to have a transfusion since many do, but in a textbook situation, the graft takes hold and starts producing new cells before a transfusion is needed. The only thing that I was given was a small bag of platelets – all of my other numbers turned the corner as predicted.
You should have nothing to worry about.
You should have nothing to worry about.
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Blackbird - Name: Rick Crow
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Feb, 2013
- Age at diagnosis: 53
Re: White blood cell count higher than expected after SCT
To clarify: There can be some ups and downs early on in one's white cell count post transplant. With rare exception, the white count will approach zero at some point, and any fluctuations that occur prior to that have no bearing on effectiveness etc.
Hope his course goes smoothly!
Hope his course goes smoothly!
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Dr. James Hoffman - Name: James E. Hoffman, M.D.
Beacon Medical Advisor
Re: White blood cell count higher than expected after SCT
Thanks Dr Hoffman. That clarification was reassuring.
Today his white blood cell count dropped to 0.1, so everything is back to behaving as expected. He's now in isolation, and has been given a dose of antibacterials and antifungal medication to try and preemptively stave off any infections.
Today his white blood cell count dropped to 0.1, so everything is back to behaving as expected. He's now in isolation, and has been given a dose of antibacterials and antifungal medication to try and preemptively stave off any infections.
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dominoman - Name: Mike
- Who do you know with myeloma?: Father
- When were you/they diagnosed?: 2014
- Age at diagnosis: 66
Re: White blood cell count higher than expected after SCT
Thanks for the update, Mike. I was hoping you would let us know how things are going.
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