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What Causes Low Lymphocyte Counts While Suffering From Breast Cancer?
Question: Hi,
Following up after this thread.
http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=177841
1. My mother's next chemo(AC) is on Friday. We got the CBC done yesterday and her lymphocytes are low. I am attaching two different reports which we got done at two different labs. Please advise if you think she can go for next chemo. When she got the blood work done, she had eaten very little for past 36 hours because of upset stomach. Do you think that could have an impact on lymphocytes.
2. After her AC protocol, she is due for 12 weekly cycles of Paclitaxel. As we have gotten quite a reduction in the size of the tumor, we are thinking of getting her evaluated for the surgery after AC and then for for Paclitaxel
3. What benefits does Pacliataxel on top of AC give her in terms of survival statistics. Seems like overall 3% from some of the studies I went through.
4. When my mother's treatment was started, her tumor size was 8cm and after 2 chemos, its <3cm. Her's is ER/PR+ and Her2Neu- cancer, which means she should not have gotten so much of pathological response to chemotherapy. We have changed her diet significantly and she has been taking mostly those foods which have shown anticancer benefits(cruciferous vegetables/green tea/rich omega3 sources etc) in different studies or have been show to kill cancer in vitro/or in vivo(animals). It seems, the food does have an impact on cancer progression. That's why we are thinking of not going ahead after four cycles of AC if Paclitaxel give only 3% benefit. Let me know what you think.
5. There have been a lot of studies on animals which suggest fasting before and after chemo leads to more effect of chemotherapy on cancer cells and less side effects. There is phase 2 trial in US underway to determine the effect of fasting on chemotherapy. Do you have any experience with any of your patients doing this?
6. The doctors did not do sentinel lymph node biopsy/FNAC of the lymph node. Is it not required? Can the markers not get lost after chemo?
Following up after this thread.
http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=177841
1. My mother's next chemo(AC) is on Friday. We got the CBC done yesterday and her lymphocytes are low. I am attaching two different reports which we got done at two different labs. Please advise if you think she can go for next chemo. When she got the blood work done, she had eaten very little for past 36 hours because of upset stomach. Do you think that could have an impact on lymphocytes.
2. After her AC protocol, she is due for 12 weekly cycles of Paclitaxel. As we have gotten quite a reduction in the size of the tumor, we are thinking of getting her evaluated for the surgery after AC and then for for Paclitaxel
3. What benefits does Pacliataxel on top of AC give her in terms of survival statistics. Seems like overall 3% from some of the studies I went through.
4. When my mother's treatment was started, her tumor size was 8cm and after 2 chemos, its <3cm. Her's is ER/PR+ and Her2Neu- cancer, which means she should not have gotten so much of pathological response to chemotherapy. We have changed her diet significantly and she has been taking mostly those foods which have shown anticancer benefits(cruciferous vegetables/green tea/rich omega3 sources etc) in different studies or have been show to kill cancer in vitro/or in vivo(animals). It seems, the food does have an impact on cancer progression. That's why we are thinking of not going ahead after four cycles of AC if Paclitaxel give only 3% benefit. Let me know what you think.
5. There have been a lot of studies on animals which suggest fasting before and after chemo leads to more effect of chemotherapy on cancer cells and less side effects. There is phase 2 trial in US underway to determine the effect of fasting on chemotherapy. Do you have any experience with any of your patients doing this?
6. The doctors did not do sentinel lymph node biopsy/FNAC of the lymph node. Is it not required? Can the markers not get lost after chemo?
Brief Answer:
Seems she has had a very good response
Detailed Answer:
Hi
Thanks for follow up. my answers...
1. I would not bother about the lymphocyte counts too much at this point. they are borderline low and holding at that level. Stomach upset should not influence that.
2. As she is responding well to chemo and tolerating well off late, I would think of completing the entire chemo (including paclitaxel) and then go for surgery.
3. I think time and again you are trying to extrapolating western data based on small node-negative tumors to your mom's case. As she has a locally advanced tumor, the benefit of taxane is much more. The absolute improvement in survival is at least 10-15%.
4. Statistics do favour ER negative tumors in terms of pathological response but we have to remember that some of ER positive tumors also do quite well with chemo. It may 20-30% but your mom may be in that group.
5. No, I am not aware of any such data and we do not recommend such practice in any established cancer center like XXXXXXX Tata Memorial or Apollo.
6. I would not recommend sentinel LN biopsy for locally advanced tumors before neoadjuvant chemo. It is still considered experimental and hazardous in my personal opinion. We should clear all the nodes at the time of surgery.
Hope this helps.
Regards
Seems she has had a very good response
Detailed Answer:
Hi
Thanks for follow up. my answers...
1. I would not bother about the lymphocyte counts too much at this point. they are borderline low and holding at that level. Stomach upset should not influence that.
2. As she is responding well to chemo and tolerating well off late, I would think of completing the entire chemo (including paclitaxel) and then go for surgery.
3. I think time and again you are trying to extrapolating western data based on small node-negative tumors to your mom's case. As she has a locally advanced tumor, the benefit of taxane is much more. The absolute improvement in survival is at least 10-15%.
4. Statistics do favour ER negative tumors in terms of pathological response but we have to remember that some of ER positive tumors also do quite well with chemo. It may 20-30% but your mom may be in that group.
5. No, I am not aware of any such data and we do not recommend such practice in any established cancer center like XXXXXXX Tata Memorial or Apollo.
6. I would not recommend sentinel LN biopsy for locally advanced tumors before neoadjuvant chemo. It is still considered experimental and hazardous in my personal opinion. We should clear all the nodes at the time of surgery.
Hope this helps.
Regards
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
hello doctor,
My mom was having fever yesterday 100, but now it is 98.6 and she is having cough and cold,
she i having chemo appointment tomorrow, is it safe to take chemo tomorrow
its 21 day cycle, or it better to recover completely before chemo.
can we delay it for 2 or three days, its her third chemo?
thanks
regards
My mom was having fever yesterday 100, but now it is 98.6 and she is having cough and cold,
she i having chemo appointment tomorrow, is it safe to take chemo tomorrow
its 21 day cycle, or it better to recover completely before chemo.
can we delay it for 2 or three days, its her third chemo?
thanks
regards
Brief Answer:
yes, it can be postponed
Detailed Answer:
If there is doubt about infection then you may postpone the chemo by 3-4 days. I don't think it will cause any major problem. Safety of the patient should be kept first.
Please discuss this with her physician.
yes, it can be postponed
Detailed Answer:
If there is doubt about infection then you may postpone the chemo by 3-4 days. I don't think it will cause any major problem. Safety of the patient should be kept first.
Please discuss this with her physician.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hi,
Is it better to give the pegrafeel injection more than 24 hours after the chemotherapy is out of the body? Lets say after 48 hours
How long does it take for the immunity to return to normal baseline levels after all chemotherapy cycles have ended?
Is there a test which also tells us how many NK cells she has?
Are there any immunostimulants available which coukd help boost her immunity?
Can we donate NK cells to her?
Thank
s
Is it better to give the pegrafeel injection more than 24 hours after the chemotherapy is out of the body? Lets say after 48 hours
How long does it take for the immunity to return to normal baseline levels after all chemotherapy cycles have ended?
Is there a test which also tells us how many NK cells she has?
Are there any immunostimulants available which coukd help boost her immunity?
Can we donate NK cells to her?
Thank
s
Brief Answer:
please refer below
Detailed Answer:
1. yes, peg-grafeel can be given on day 3 or 4. In case of lymphoma, day 4 was shown to be better than day 2. In breast cancer there is no such study.
2. Full recovery of immunity will require at least 6 months but reasonable recovery is expected by 1-2 months.
3. Answer to all other questions is no at this point. Much more research is required before we can draw any conclusion on these.
Regards
please refer below
Detailed Answer:
1. yes, peg-grafeel can be given on day 3 or 4. In case of lymphoma, day 4 was shown to be better than day 2. In breast cancer there is no such study.
2. Full recovery of immunity will require at least 6 months but reasonable recovery is expected by 1-2 months.
3. Answer to all other questions is no at this point. Much more research is required before we can draw any conclusion on these.
Regards
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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