High WBC ANC on immuno GVHD

[rar]

I am 4 years post transplant. I am on prednisone, tacrolimus, and imbruvica for GVHD. I just had my monthly blood tests. My ANC and WBC had been on high side of normal. This morning ANC 9.6 (1.7-6.7) WBC 13.1 (3.9-10.7) HGB 12.6 (13.4-18.1) platelets 238. Is it normal to have high ANC on immunosuppressants? Is the high ANC making a major contribution to my GVHD? Anyone else in a similar situation? My doctor seems to gloss over the situation.

Ray

[Neil Cuadra]

Ray,

How long has your ANC been elevated? Is it up or down compared to last time?

From what I've read, this condition is called neutrophilic leukocytosis and isn't itself harmful, but is a symptom of an underlying issue, such as an infection, inflammation, tissue damage, or trauma. I hope that your doctor's inattention to your high ANC is a sign that it's not a concern for you, but I haven't heard mention of this situation before.

Possible causes mentioned for neutrophilic leukocytosis are infections, inflammation, tissue damage, and trauma, but when you've had a transplant the explanation could clearly be different.

And here's something ironic: For people with chronic neutrophilic leukocytosis, one of the possible treatments is a bone marrow transplant (see article)!

[rar]

Hi Neil,

Thanks for the response.

As I understand ANC is the donor immune system that is attacking me and I am taking immunosuppressants to get rid of these guys. It doesn't seem to be working; aggravating my GVHD.

ANC for the past year has been up and down.
Neutrophils Absolute
1.7 - 6.7 10*9/L
5.3 3.7 3.9 4.6 4.4 3.5 3.2 3.1 3.7 4.5 4.0 6.6 6.6 8.8 6.6 5.7 5.5 4.7 4.9 9.6

I have no infections in the past year. I had a sciatica attack 2 months ago and a recent steroid shot for it. Transplant was a piece of cake in comparison to the GVHD. I guess I could do it again at 78. My donor sister says the GVH is in retaliation for my teasing her when we were young. Her immune system is the boss.

Ray

[Hopeful]

Hi Ray,

I remember seeing my ANC and WBC increase while on prednisone. If your doctor did a differential and reported a left shift/bands, the raised WBC could be a sign of an infection.

Your sister's comments are funny Wishing you well!

[DanL]

Ray,

Depending on the dose of prednisone, you may have more white blood cells, specifically ANC, than normal as it is said to release reserves of white blood cells into the blood stream. As others have noted, it could also be caused by bacterial infection or some other cause. I know that when I was on prednisone years ago, my ANC jumped to almost 20k from 5k, but that was 100mg per day.

I may be off base, but my understanding is the following:
Tac - WBC neutral more or less
Pred - tends to increase WBC, but weakens their ability to do the job
Imbruvica - tends to reduce WBC

I am wondering if the timing of your blood test has been at a consistent point with your cycles of Imbruvica - meaning that you may be at a different stage of blood count recovery than the last couple of tests.

Dan