hi, everyone,
I've just had the latest blood test result come back. My doc called me to his office today tell me all my count is very low, especially the platelets only 40, RBC 120, WBC 2.1. He has to stop my medication (Imatinib) for one week to see if the counts are coming back. It is only 55 days into my treatment. I am a bit worried if I would be able to resume the treatment, does that means I am imatinib intolerable or its just temporary. If I do resume treatment, would my body become imatinib resistant. Every time I get a call from my specialist, I knew something went wrong. My result from one month ago was not too bad, platelets 379, RBC 128, WBC 3.3. I don't know why it dropped so much within one month. Can anyone help me this question?
thx
William
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Low Platelets, low WBC, low RBC
hi. it's very common to suffer from low counts early in treatment. most of the times the counts will return to normal after a drug break. you can do a research in this forum and will find many cases like yours. the vast majority with sucessfull treatments. I live with low platelets (around 80K). try not to worry much. at least, now you know the reason of yours pin points and why they didn't come back to normal. good luck!
Hi William,
I m not too sure of this and I may be mistaken in my reasoning but I will try to set your mind at rest.
If you think about how TKIs work it might explain why people sometimes suffer from low blood cell counts during the first months (or longer) of therapy.
All TKIs, including imatinib, are designed to target and shut down the protein that drives the PH+ cell - the Bcr-Abl protein - however, during this blocking or inhibiting process other cells, like platelets and red blood cells, are 'in the mix' and through the myriad of cell processes going on continuously these cells can also be affected.
Often, red blood cells are suppressed by TKI therapy, so people suffer some level of anaemia (hence tiredness/fatigue that is a commonly reported side effect).
Platelet counts are also seen to drop significantly after therapy is started - and remember high platelet counts can be a feature at diagnosis, so it is fair to assume that platelets or their functionality are in some way involved in the pathogenesis of this disease.
So if the TKI drug is doing its job well, then you will see a reduction in abnormal - and abnormally functioning- cells, and it can take some time for the marrow to start effectively producing a normal amount of normal (PH neg) and normally functioning cells.
Remember, platelets develop from the myeloid stem cell line- eventually produced by megakaryocytes....
see here:
http://en.wikipedia.org/wiki/White_blood_cell#mediaviewer/File:Hematopoi...
Your doctor should be able to give you some idea of how long you will need to be off therapy- sometimes it is couple of weeks- but I am sure you will see rise to more normal levels quite soon and will be able to resume therapy.
It should not affect your eventual response and this does not mean that you are resistant or intolerant... your body has to be given the chance to get rid of the high load of abnormal cells that you have at diagnosis so it can start producing normal ones.
BTW: You need to tell your doctor if you are taking NSAIDS for pain relief- i.e aspirin - which can affect platelet function.
Hope this is helpful,
Sandy
hi, Sandy,
It's so nice that we always get a prompt and professional response from you. I guess it is not incidental that I have some bleeding under my fingernails together with the red pinpoint spots (mainly attributed to very low platelets). I wish that I can resume my medication quickly, just have to see the result in a weeks time. I am wondering if the number of cancerous cell is likely to bounce back with the normal cell after one week drug free period. Anyway, your posts made me feel a lot better knowing that I am not the odd ones. Much appreciated for your help.
William
hi, Lucas,
Thanks for the response. Do you mind if I ask what is the lowest platelets number you have reached during therapy, and what does your doctor think is the safe limit for platelet.
William
Thanks Lucas and Dennis. By looking at fellow CMLer's posts, I discover that it is really up to the doctors to decide for individual cases, and possiblly every doctor has their own standard, ranging from below 50 to below 10 platelets number. It is difficult to judge at this point the risks and the benefits. I had bleeding under finger nails, and occational gum bleed, I guess it could be dangerous if condition get worse. Anyway, I am getting my blood tested for PCR on Wed. We will see what happens.
William