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Lymphopenia

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Hi All,

One of the hazards of having CML and also of having to take a course of tki therapy,especially over a long period of time, is a low or abnormal lymphocyte score.Some consultants will tell you that it is a part of the condition of having CML and others that the tki drug will also cause it.

My latest score is 0.7 which does not compare well with a normal range of 1.5 -4.0.A few days ago at my consultation I asked my specialist if this was a cause for concern and he said just keep the immune system up to scratch if possible.I understand that the lymphocytes are comprised of B and also T cells and as we know these are quite important in the fight against Covid and other infections.However there are with white blood cells other measures such as the total or absolute white count and neutrophils which if normal would indicate that one can fight infection.The health of the bone marrow is also indicated by scores of monocytes, basophils etc.

So I am going to up my Vit D daily dose to 8000 iu daily for a while and also re think what is a pretty healthy and vitamin rich diet but perhaps also increase my probiotic intake for a very healthy gut etc.In addition I will have my 5th jab of Pfizer very soon .

Has anyone else experienced a low lymphocyte count or lymphopenia and if so what action if any were you advised to take?

Thanks

John

John,

Have you measured your vitamin D blood level? It's a good idea to know your D baseline so you take an appropriate dose. As we head into summer, less D is likely to be needed to keep a protective level. But keeping vitamin D in a range of 55 - 100 ng/ml is ideal with 70-80 a good target.

Interesting paper linked below on vitamin D and lymphocyte subsets.

Thanks Scuba for your response,

My Vit D is monitored every 6 months and is in the range 70-80 but I am aiming as you have previously posted for 100-120.

If my Lymphocytes dip further in the future I might ask for some kind of measure of B and T cells just to see how strong my immune system is .

Interesting article.

John

John,

70-80 is the ideal sweet spot for vitamin D levels. More is not better when it comes to vitamin D blood levels. Maximum benefit is around 70 and then it trails off (slightly) suggesting more is not needed to get maximum benefit. A key point to remember is that vitamin D is stored in the liver and fat. At 70 ng/ml, the vitamin D receptor in these cells are saturated. Vitamin D toxicity can occur if levels rise above 150 ng/ml and become noticeable above 200 ng/ml. keep this in mind.

(I never have written to aim for 100 - 120 ng/ml unless it is a mit-type. I hope not. I aim for 70-80, so whatever you have been doing is working.)

A question - why are my GP and haem both happy with my current Vit D levels at 53. I have been taking 1400IUs daily for a couple of years after my levels were " low". I shall continue on the prescribed 1400 IUs. . I thought the optimum level was 70 but my GP told me on Tuesday that it used to be 70 but now it's 50. 

 

Confused

Chrissie

Chrissie,

I would not expect a GP to have in depth knowledge of how Vit D impacts on the immune system and nor would I expect them to understand the mechanisms of CML and how tkis themselves may as treatment lower immunity in the similar effects that chemotherapy might have.A level of 50 is putting the bar quite low;if you dose at say 4000 iu daily you are pretty safe and  not in danger of overdosing.If you read the literature and reports then an ideal level is 70 -90.There is a reluctance in the medical profession to acknowledge the importance of Vit D (vitamin use is not really medicine some think !) especially in indoor workers who never see the sun and in some ethnic groups that might avoid the sun as it further tans the skin (not a racist comment I suggest).My partner is Thai and she will avoid the sun at all costs so I insist that she takes a good dose each day of Vit D in tablet form.There are not that many foods that contain Vit D -perhaps wild fish and portobello mushrooms grown outdoors are exceptions I believe.

Holland and Barrett do some packs of 4000iu Vit D that are not expensive .My specialist insists that I take a minimum of 4000iu each day and sometimes in winter a little more -as one gets older there is a danger of Vit D depletion and those other age related conditions are not helped if one had Vit D insufficiency

Regards

John

Just to remind you that in the UK (and other EU countries) D3 is measured in nmol/L rather than ng/ml so you would need to convert your test result if you are following US based research/recommendations.

Sandy

Conversion factor: 1 ng/ml = 2.5 nmol/L

60 - 80 ng/ml = 150 nmol/l - 200 nmol/l