The approach for my soft landing has been suddenly interrupted by some unexpected turbulence. I had a CBC and FACS performed on Monday. For the most part, my counts were good, but as shown in the plot below, the one exception was a doozy -- my absolute neutrophil count dropped dramatically from 1.97 two weeks ago to .81 on Monday. This sudden drop definitely had me concerned, but to my relief the other counts are still good -- the lymphocyte level remained steady, my platelets increased slightly and my liver enzyme levels are now well within the normal range.
My FACS results came in on Thursday and were still negative -- no detectable hairies in the peripheral bloodstream. Everything else is good, but the neutrophils have dropped suddenly about 14 weeks after my last Rituxan treatment (12/28/09). What's going on? The initial direction from Dr. K is to wait until my marrow biopsy on May 10th to evaluate the marrow function, but after some more investigation, my best guess is that I've experienced a side-effect of Rituxan known as Rituxan related late onset neutropenia (RRLON).
A cursory evaluation of the available research papers on RRLON indicates that in a lymphoma study in which patients were treated with both chemo and Rituxan, 23 of 107 patients experienced some form of RRLON. The typical median ANC nadir point was .61, and required 4 weeks to recover. I've asked Dr. K for his opinion and a response is pending. In my opinion, another CBC by next Wednesday would make sense to quantify the nadir and determine whether I'm still on the downturn or moving toward recovery.
I'll keep you posted.
BTW: here's an interesting article regarding the health care debate ;)
Update:
Just had another CBC today (4/29) per my request, and the news is good! The late-onset neutropenia (LON) has resolved and all my counts are in great shape (except the platelets). I'm very confident that this was a Rituxan-related event and pleased that my neutrophil level is now well within the normal range. As you can see in the ANC plot below, the neutrophil level is almost close to the peak level since I've started collecting CBC data. Even better, my WBC is the highest it's been in years considering that prior to treatment a large percentage of the WBC consisted of hairy cells. I'm very happy!!!
A cursory evaluation of the available research papers on RRLON indicates that in a lymphoma study in which patients were treated with both chemo and Rituxan, 23 of 107 patients experienced some form of RRLON. The typical median ANC nadir point was .61, and required 4 weeks to recover. I've asked Dr. K for his opinion and a response is pending. In my opinion, another CBC by next Wednesday would make sense to quantify the nadir and determine whether I'm still on the downturn or moving toward recovery.
I'll keep you posted.
BTW: here's an interesting article regarding the health care debate ;)
Update:
Just had another CBC today (4/29) per my request, and the news is good! The late-onset neutropenia (LON) has resolved and all my counts are in great shape (except the platelets). I'm very confident that this was a Rituxan-related event and pleased that my neutrophil level is now well within the normal range. As you can see in the ANC plot below, the neutrophil level is almost close to the peak level since I've started collecting CBC data. Even better, my WBC is the highest it's been in years considering that prior to treatment a large percentage of the WBC consisted of hairy cells. I'm very happy!!!
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