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Low White Blood Cells- Chemotherapy

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Hi David- I have a current situation on which I would greatly appreciate your input. Some background: I was diagnosed last October. I underwent a relatively short period of Revlimid/Velcade/Dexamethasone treatment, and have been in remission since April. There were many difficult periods in between, including 4 months in a wheelchair. Currently, I feel very good. However, I have been battling a low White Blood Cells and low ANC throughout.

Often my oncologist would have to suspend treatment due to the low white blood cells. At one point, treatment was suspended for 5 weeks. Currently, I take a low maintenance dose of Rev (10mg), and they even had to take me off that last week due to low white blood cells.

My white blood cells last week was 1.9, and my ANC was 0.6. I started Beta Glucan after those results, and my lab work taken yesterday showed my WBC at 2.1 and my ANC at 1.0. I attribute the modest improvement to the Beta Glucan – the doctor will likely claim it was due to not taking Rev for one week; perhaps both contributed. In any event, they advised me to restart my Rev yesterday, but also want me to start taking the Zarxio (or Neupogen) shots again, something I did for a while during treatments.

I am a young 63 year old. Prior to this diagnosis, I was not on any medications at all, worked out 5 days a week, and ate and lived a healthy lifestyle….aside from the stress of my job. (However, I have, for as long as I can remember, had a low WBC; always in the normal range, but always at the very low end of normal.

Ultimately, with the results of a bone marrow biopsy taken in late March, my oncologist agreed to remove the Velcade and Dexamethasone, and to reduce the Revlimid from 25mg to 10mg, and he also agreed that I could stop the Zarxio shots (I took a total of 7 shots, over roughly a two month period).

That is where I stand today, aside from having to suspend the low dose Rev last week due to low ANC results. I also take a myriad of supplements, including

  • curcumin,
  • vitamin D3,
  • vitamin K2,
  • boron,
  • Resveratrol,
  • Berberine,
  • mistletoe essential oil, etc.

The low White Blood Cell and ANC numbers concern me. I know many MM deaths are due to infections. I have done all that I can think of to increase those numbers using more natural approaches – high dose IV vitamin C, zinc supplements, vitamin E, vitamin B-12, beta glucan, garlic, black pepper, oregano, etc. – and nothing seems to move the needle all that much.

Would you, if you were me, continue the low dose Rev and go ahead and take the Zarxio shots? Is there anything that I am missing or that you would suggest I consider to increase my WBC and ANC numbers?  I obviously want to try to keep the myeloma at bay, but also want to try to get my WBC and ANC numbers into a safer range. Those two goals sometimes seem in conflict. Mr. Myelosuppression-

Dear Mr. Myelosuppression-

The challenge you write about, myelosuppression in general and neutropenia in particular, is one of the most common side effects I read about for MM patients. You are correct that infection is a leading cause of mortality for MM survivors.

RVD induction therapy is the standard-of-care for newly diagnosed MM patients- “a relatively short period…” leading to remission is good. Meaning, you didn’t over-treat your mm initially leading to problems with myelosuppression.

Zarxio is a biosimilar to neupogen. The FDA says that the two are almost the same. I have no reason to think that they don’t act the same for myelosuppression. Both have side effects.

As you have experienced, the solutions to neutropenia are:

  1. reduce the dose or take a therapy vacation and wait for your WBC count to reach normal-
  2. undergo Neupogen and wait for your WBC count to reach normal-
  3. eat and supplement (see the article linked below) to increase your WBC-
  4. I agree with your list of nutritional supplements-

Because I have bias against chemotherapy or I should say that I see chemo causing as many problems as it solves, I have to include an integrative solution to this problem.

Because you are in remission currently, the revlimid that you are taking is maintenance therapy? If this is the case, and if you are already in remission,

  1. consider stopping all chemo altogether-
  2. consider reducing your 10mg dose further to either 5mg or even 2.5mg (I have read that revlimid can come in 2.5mg pills)-

You are struggling with what I consider the cure vs. control debate in MM. I’ve linked an essay about this below.  I believe in the control side of the debate and conventional oncology believes in the cure side of the debate.

Mr. Myelo, as you can see I am always reluctant to answer questions directly. I am inclined to present the evidence to MM patients and let them decide what they think is best for them.

Let me know if you have any questions.

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Treatment of Myeloma: Cure vs Control

“Although not often openly acknowledged, “cure vs control” is the dominant philosophical difference behind many of the strategies, trials, and debates related to the management of myeloma. Should we treat patients with myeloma with multidrug, multitransplant combinations with the goal of potentially curing a subset of patients, recognizing that the risk of adverse events and effect on quality of life will be substantial? Or should we address myeloma as a chronic incurable condition with the goal of disease control, using the least toxic regimens, emphasizing a balance between efficacy and quality of life, and reserving more aggressive therapy for later?

To be sure, if cure were known to be possible (with a reasonable probability) in myeloma, it would undoubtedly be the preferred therapeutic goal of most patients and physicians. But this is not the case. Myeloma is generally not considered a curable disease; however, new definitions of cure have been suggested, including operational cure, which is defined as a sustained complete response (CR) for a prolonged period., Cure vs control is debated because the strategies currently being tested are not truly curative but rather are intended to maximize response rates in the hope that they will translate into an operational cure for a subset of patients…”

How Can I Increase White Blood Cells?

“You can increase white blood cells (WBCs) by taking certain medications and eating immune-boosting foods. Maintaining a normal level of healthy white blood cells can help reduce the risk of infection and is a key component of overall health. If you have a low WBC count, called leukopenia, you may be at an increased risk of developing infections.

This article discusses the function of white blood cells, the causes of increased and decreased white blood cell counts, and the medications and foods that can help you maintain a healthy white blood cell count…”

4 Common Vitamins to Help Increase White Blood Cells

White blood cells, also called leukocytes, are a type of blood cell that help fight infections 4. There are five types of white blood cells, and each is produced in your bone marrow. When you are exposed to an infection, white blood cells leave your bone marrow and travel to your bloodstream, where they attempt to destroy the cause of infection. The production of white blood cells is largely dependent on the presence of vitamins in your body…”



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