please share lymphocytes counts before ATG, day1 of ATG and after 1 month of ATG

[pvinod]

Hi All,

I have started this thread to share WBC differential count specially lymphocytes and neutrophils before ATG, day1 of ATG and after 1 of ATG.

we all or our relatives are suffering from Aplastic anemia, we share our feelings, questions, knowledge here for getting some ideas / hint from this forum.

Now, I want to make out a survey that in which patient after ATG course response came early and response came late. As per my knowledge it depends on lymphocytes counts. if you have a lower number of lymphocytes after ATG than you can get response early. and if you have a still higher lymphocytes after ATG you will get response late. Work of ATG is to kill the bad T-lymphocytes which attack on own stem cell. so when you take the ATG that T-lymphocytes are kill and after that you have to took the cyclosporine so that T-lymphocytes cannot be become active. When they finally turned off , they stop to attack on stem cell and and count start to grow. You can notice this from that on day1 of ATG , all your lymphocytes goes. after that they should be back but in range, not out of range or not as equal before ATG.

Anyway this is my theory, I want to make it confirm by comparing lymphocytes and nutrophils counts in all patient which have response came early and which have late.

please share your counts . I have started first from my one.

Differential WBC before ATG
neutrophils: 2%
Lymphocytes:95%

Differentia WBC day1 ATG
neutrophils: 44%
Lymphocytes:11%

Differentia WBC after 1 month of ATG
neutrophils: 2%
Lymphocytes:95%

please share yours in these terms.

[KimO]

I went back and looked at Shauna's records and found:

Before ATG -- WBC 3.7
Neutrophils 20%
Lymphocytes 78%

One day after ATG -- WBC 1.4
Neutrophils 80%
Lymphocytes 9%

One month after ATG -- 9.8 (keep in mind she was on C-GSF and had a bad --and as yet undiagnosed-- infection)
Neutrophils 68%
Lymphocytes 22%

I've noticed since we are 3+ years out that an indication of whether things are in check -- for her anyway -- is the ratio of lymphs to neuts. When she relapsed that turned upsidedown with lymphs at a 2-1 or better. When things are going ok it is around 2-1 neuts to lymphs.

Her counts started increasing at about 5-6 weeks post ATG.

HTH
Kim O.

[pvinod]

Hi KimO,

thanks for replying and sharing counts.

here we all can see that after the ATG , lymphocytes are in range at 22%, not goes as before ATG 78%. and that's why she got the immediate response in 5-6 week. congress KimO for good response.

I think my theory for judge when response come is true. Lymphocytes number after one month of ATG we can judge when response will come.

[Hopeful]

Dr. Neil Young once gave a presentation that showed that having a high Absolute Lymphocyte Count (ALC) or high Absolute Reticulocyte Count (ARC) *before* ATG was a favorable predictor of response, as it indicated minimum bone marrow damage. A high ARC was defined as > 25k/ul. A high ALC was defined as > 1k/ul. Response rate was over 80%!

You can check out his presentation on this titled "Advances in Treatment..." at:
https://live.blueskybroadcast.com/bs...=1016&CAT=1592

All of his presentations are very interesting, and he has many positive things to say about the probablility of children responding to treatment.

[pvinod]

Hi Hopeful,

Thanks for information and link.

I just confused in ALC and ARC numbers. how it is in percentage? means lymphocytes is 50%, 60% etc? retic count in 0.2? Here in India , Ahmedabad it shows in this way.

[Hopeful]

Hi pvinod,

You can calculate Absolute Lymphocycte Count (ALC) if you know the total White Blood Cell Count (WBC):

ALC = WBC * %lymphocyctes

Likewise, you can calculate Absolute Reticulocyte Count (ARC) if you know the total Red Blood Cell Count (RBC):

ARC = RBC * %reticulocytes

[JodyW]

Can you calculate the RBC if you have the Hgb, wbc and Plt.?

[Neil Cuadra]

Originally Posted by JodyW

Can you calculate the RBC if you have the Hgb, wbc and Plt.?

No, because RBC tells you the count of red cells in a standard volume of blood while HGB tells you the amount of hemoglobin in that blood, so they measure different things.

The ratio of HGB and RBC is called your MCH (mean corpuscular hemoglobin), so if you know two out of three of HGB, RBC, MCH then you can compute the third one.

HGB = RBC x MCH

RBC = HGB / MCH

MCH = HGB / RBC

[JodyW]

Neil,

Im hoping you can help me figure this out. I am trying to determine if Trev falls in the >25000 arc or <25000 . Also what his ALC would be. Unfortunatly I dont have his RBC count at time of diagnosis. His Hgb was 3.1 so I assume his RBC is less then his Hgb correct?

So im not sure from the calculation hopeful posted what a * represents. so here are his numbers.
WBC =2.8
Lymphocytes 80.5%
ALC= (would it be <1000)
and
ARC
Reticulocytes 1.4%
Hgb 3.1

Does he fall in the 80 or 41%? from the presentation?
In the presentation he talks about the corrolation to the degree of damage to the bone marrow and I know Trev had only 4.5% stem cells left at diagnosis.

[Neil Cuadra]

* means the same as x, namely multiplication.

So ALC is WBC times the lymphocyte percentage: ALC = 2.8 x 80.5 = 225.

You don't have enough information to compute Trevor's ARC.

I know you are looking for reassuring news. Just remember that statistics are based on results for groups of patients and don't give us any guarantee (good or bad) for the prognosis for one particular patient. That's why knowing how Trevor is doing week to week is what really counts.

[JodyW]

Thanks Neil. I appreciate your quick reply.

[JodyW]

Im sorry for the clarification, but if its 2.8 x 80.5=225.4 why do you say its 2254? Why do you move the decimal, Or if its 2.8 x 80.5% does that translate to 2.8 x .80 ? I know Im letting everyone out there know im math challenged . But yes I am looking for reassurance.

[Karenish]

We all look for re-assurance and this is quite natural. But I would caution looking into things too much - like a previous poster has said...research is based on Norms and on those particular individuals who took part in the statistical work. Even with the worst possible predictions people do and will get better! Sometimes too much knowledge can be a bad thing - I nearly gave up when everyone said "oh if you havent responded by 6 months then they consider the treatment has failed" my consultant does not buy into this, he said that he was going on what my marrow looked like at 6 months and that he saw a tiny improvement and based on this took advice from prof. marsh down in London who said he was correct to wait a while....now 10 months in and my figures are slowly climbing which goes to show that certain predictions were wrong. I am no way out of the woods yet, but I now no longer go searching and searching on the internet only to scare myself half to death with the statistics of survival. We are all on the same journey, we are all going to die one day....just I would rather it was in about 25 years from now (well into my late 70's by then!) Lots of stress and worrying does not help with the healing process and even people who are 100% fit and well go out in their cars and die in road traffic accidents! In essence, I am not preaching to not find out information, but to just take things as statistics, we are all different, we all heal at different rates, we are unique...take each day as it comes if you can. xxx

[Neil Cuadra]

Originally Posted by JodyW

Im sorry for the clarification, but if its 2.8 x 80.5=225.4 why do you say its 2254? Why do you move the decimal, Or if its 2.8 x 80.5% does that translate to 2.8 x .80 ? I know Im letting everyone out there know im math challenged . But yes I am looking for reassurance.

My post was wrong so I corrected it above. Sorry for the mistake.

What's the latest update from Trevor? Do you have current news?

[JodyW]

Thank Neil, I appreciate the update. I absolutly agree with everything Karenish says and I try and succeed alot in believing in the future. Update on Trevor- Since he began cyclosporin (4/11) he has had 5 infections each from lack of care to a pic line or a port. Unfortunalty the treat him with Bactrim which I think needs to stop but they say taht is all they give. And his infections are MRSA now. With all that he was responding to the treatment until one of the infections caused him to become transfusion dependent again. His platelets recovered from this a second time and are looking great. The last count was 113. I thought his Hgb was going to also rebound as it had been 4 weeks and no transfusions. Unfortunatly they are on a decline again and transfusion of Hgb continue. Im confident that these to will rebound in time.
With that said, my question becomes, if Trevor was transfusion independent for a period of time and then got the infection and they didnt give him his meds for 3 days and then he became transfusion dependent again, would this becalled a response and a relapse.. or is it a partial response and we not consider it a relapse because it was caused by an infection and his not getting his cyclosporin for 3 days.

Pvinod- I am sorry, to misdirect your thread, but wanted you to know, I will post Trev before and after ATG numbers once I recieve his records.

[Hopeful]

Hi Jody,

Just a little clarification...

You must convert the % to the decimal notation.

ALC = 2.8k x .805 = 2.254k

From my recollection of Dr. Young's presentation, this meant that he had a high probability of *responding* to IST, as his ALC was above 1k at the time of diagnosis. If someone responds to IST, they generally have a higher probability of survival. As others have pointed out, these are just statistics and there are always exceptions.

It looks like Trevor did have a strong response to IST but has been plagued by infections. Infections and any stress on the immune system are dangerous for bone marrow failure patients as we don't have the large reserves of blood cells that normal people have. As long as Trevor's body is able to fight the infection, and his counts come back up, it is not considered a relapse. If his counts don't come back, that is an indication of a relapse.

Because RBC's last for so much longer than WBCs and Platelets, it's not unusual to see them lag behind in their fall and rise.

[JodyW]

Ahh that was the missing peice.. 2.8 is actually 2.8K ..so its >1000. Thank you.. Happy New Year.