Lymphocytes way down, now way up...

[evansmom]

Hi everyone.

Evan has not required a platelet transfusion since Dec. 24 and actually started making his own platelets. Over the next two weeks, he went from 15 to 20, and all the way up to 31. We were so delighted. All the while, he continued on G-CSF 3xweek. His ANC was often ridiculously high at 31. I had been talking to the doctor repeatedly about my desire to get Evan off of the G to see what his ANC would be on it's own. I theorized that if his platelets were slowly rising in view of so many stems being asked to become neutrophils, if we take away the G, then maybe more stems could differentiate into platelets, etc. Seemed reasonable. Well here we are now and basically at around the same time that we stopped the G, Evan's platelets have been coming down (not up, as we expected) by about 1 a day. Other things I have noted around the same times are:

-At the time of rising platelet counts, Evan's lymphs were way down at around 5% +/- and I believe his cyclo. level was upwards around 190-200. He was still receiving G.
-At the time of dropping platelets, Evan's lymphs have skyrocketed to 53% (highest they've been since ATG), and his cyclo. level went as low as 108 and is still only around 135. He was no longer receiving G.

Question: could it be that the G was keeping the marrow so busy with over-producing neuts that there was not much left to make lymphs? Or do you think this has more to do with the lower cyclo. level?
I'll be asking all of this when we go on Tuesday, but I thought I'd inquire here also.
It's so hard not to overthink things to distraction but I can't stop. I know the higher lymph count is dropping the platelets but how do we stop it?

Thanks and best wishes for the best of health to all.

[Marlene]

Just wondering if he's catching a cold or another type of viral infection? You will see a increase in lymphs with viral infections. All fevers and infections can chew through platelets.

[evansmom]

Hi Marlene.

Yes, I was thinking the same thing after doing a lot of reading about elevated relative lymphs with normal absolute lymphs. He is not showing any signs of illness...yet! Hopefully his platelets will be on the upward swing again soon.

[Marlene]

And I saw Dan's reply to this on AAcentral. Makes sense. I do remember how disturbing it was when John stopped G-CSF. To watch the ANC drop that much is scarey stuff and really plays with your emotions and confidence. Hopefully things will settle down shortly and you'll see a new pattern evolve.

Hang in there,
Marlene

[evansmom]

Yes, he has a cold and a low grade fever...but surprise surprise, his ANC was up to 3.7 from 1.1 today. Quite happy about that.