understanding immunity in cll prior to treatment

[Guest guest]

Wondering if Dr. Furman can shed some light on the subject of low t and nk cell

levels prior to treatment. Others have been pondering these cells and have asked

some questions. These lymphocytes seem to only be addressed in a treatment

environment. Mine were tested due to multiple infections and found to be quite

low.

cd3 t cell 6% (49-87)

CD 16 +CD56 (NK cells) 2% (6-35) (mayo lab values)

Since we know that most treatments lower these immune fighting bastions I wonder

if there are treatments that take those levels into account.

8 years ago mine were tested, again during a viral infection and at that time

they were done by a different lab, but

cd 3 58% (57-85) and cd 16+56 NK 7% (4-25) (quest lab values 2002)

At that time I was told that I was at a higher risk of malignancy due to the low

nk, the t cells were borderline and should be watched deopending on what else

was going on..

In any event they've gone down with no treatment.

I have been told that my low t cell count is already probably goes a long way

toward the explanation for many of my infections, particularly viral, as in

shingles, which we usually hear of post treatment, and that my low nk's are

probably asleep which has given my squamous such a head start, also usually more

common after treatment in cll. I gather these tests would be done prior to

treatment? but since I already know what they are is there treatments that are

less damaging to those subsets that could help.

Are there treatments that can raise those cell counts, either prior to or after

treatment? I think you said they don't recover, did I recall that correctly?

Thanks so much,

beth fillman

zap 70 pos (80%) 11q wbc now 41, lymph nodes in all zones. frequent viral

infections, on ivig.

[Guest guest]

Beth,

You posed a good question that I've never seen before. I was a few years into Dx prior to being tested, and it was only done so at my urging. Like you, I questioned the push of the currently available treatments making the situation worse rather than better. But again like you, I found out that CLLers are stuck between a rock and a hard place. There is no easy answer. Fludarabine, steroids and Campath will go after T cells, and all standard treatment drugs will go after NK cells.

You will find a lot of information about what different treatments do on Venket's old website (CLL Topics) but it sounds like you've already been there, or have a clear understanding of the issues we have at hand. It's been my experience that Rituxan will go after NK cells, and that's one of the reasons a number of hem/oncs use concurrent or prior injections of GM-CSF or G-CSF. These Stimulating Factors come with their own risk according to at least one medical abstract posted by . For me, the impact on T cells was minimal, but disconcerting when the numbers were so low to begin with.

There was an abstract written in the 1980s published by the Mayo Clinic that stated high doses of Cimetidine increased NK cells in CLL patients. I tried it to no avail except for goosing my WBCs upward.

Perhaps someone on the list will comment on whether Revlimid actually "modulates" the immune system rather than tanking it, and perhaps Dr. Furman could comment on clinical trials that may look promising for improving immunity, but we are not there yet.

Ann

[Guest guest]

The thing to remember here is that given the large numbers of CLL lymphocytes in

the blood, one has to look at the absolute numbers, not the percentages. What

is listed below are percentages.

CLL patients prior to treatment tend to have normal numbers of T and NK cells,

but they do not seem to work very well.

Rick Furman

>

> Wondering if Dr. Furman can shed some light on the subject of low t and nk

cell levels prior to treatment. Others have been pondering these cells and have

asked some questions. These lymphocytes seem to only be addressed in a

treatment environment. Mine were tested due to multiple infections and found

to be quite low.

>

> cd3 t cell 6% (49-87)

> CD 16 +CD56 (NK cells) 2% (6-35) (mayo lab values)

>

> Since we know that most treatments lower these immune fighting bastions I

wonder if there are treatments that take those levels into account.

>

> 8 years ago mine were tested, again during a viral infection and at that time

they were done by a different lab, but

> cd 3 58% (57-85) and cd 16+56 NK 7% (4-25) (quest lab values 2002)

>

> At that time I was told that I was at a higher risk of malignancy due to the

low nk, the t cells were borderline and should be watched deopending on what

else was going on..

>

> In any event they've gone down with no treatment.

>

> I have been told that my low t cell count is already probably goes a long way

toward the explanation for many of my infections, particularly viral, as in

shingles, which we usually hear of post treatment, and that my low nk's are

probably asleep which has given my squamous such a head start, also usually more

common after treatment in cll. I gather these tests would be done prior to

treatment? but since I already know what they are is there treatments that are

less damaging to those subsets that could help.

>

> Are there treatments that can raise those cell counts, either prior to or

after treatment? I think you said they don't recover, did I recall that

correctly? Thanks so much,

>

> beth fillman

> zap 70 pos (80%) 11q wbc now 41, lymph nodes in all zones. frequent viral

infections, on ivig.

>