Chemotherapy

Ted, one of the factors with chemo for CLL is the status of the lymph nodes. There are several authors who believe that these increases in lymphocytes shortly after chemo are related to a movement of lymphs from the nodes (where they would never have been counted since we can't do that) into the peripheral blood (where they are counted).

As to the granulocyte drop - it is fairly common that the marrow can become more sensitive to the medications and less able to rebound back to its regular state. Many of you may have noticed this in other ways - the increasing fatigue over the span of a treatment cycle is a good example. The numbers will rise shortly with the neupogen.

Denise - the decision to start chemotherapy is not based on the white count alone but on lots of other elements. Anemia and thrombocytopenia are two of the biggies as are your own signs and symptoms. Elizabeth explained the reason for not using procrit very well. Procrit only works when you have 1) the appropriate number of stem cells which are capable of committing to the red cell line ; 2) the available space and environment for them to actually mature into red cells; and 3) the blood stream environment which allows those cells to live the 120 days that are supposed to.

At present, from your values, my guess is that your physician does not believe these conditions are met.

As to the chemotherapy lowering your granulocyte and platelet counts - yes that is a possibility. However, you have to lower the lymphocyte burden in the marrow - before that tumor burden does further damage to the marrow. On the good side, there are many people with not-so-elevated white cell counts who do quite well with chemo. Good luck.

Treatment for any malignancy is a tricky thing. You don't really know where all the cells are; you don't have a clear idea of how many of them there are, and when you treat them you don't know if you killed any of them. A lot of what you know is indirect. You know that when a white cell count goes down, cells are being killed. Since you know that WBC are about as hard to kill off as malignant cells, you are reasonably sure that these cells are going to be damaged. From the numbers you listed and probably the CT scans or other tests, you probably had a good response here. One problem here is that you don't know how many of the malignant cells have been damaged or , as has been spoken about here, gotten smart enough to develop resistance to the drugs. So you need to use the medication for a longer period of time than seems necessary at first glance because you want to make sure that you have gotten enough medication to enough of the malignancy to do some good. Better to take one or two extra doses than to leave some still functional malignant cells around.

Can his WBC go too low? Yes, but that is the reason for the CBC results prior to the next round of medications. Physicians will make a decision to give the usual dose or less than the usual dose or postpone the dose based on the numbers that the CBC gives them. If it does happen that his WBC drops to a lower level, there are a number of different options to help them return to a better state. Many people on this list have had this experience.