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Long term treatment effects on bone marrow suppression

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  • Long term treatment effects on bone marrow suppression

    Hello I was hoping to get other's experience/advice on blood count recovery after treatment is over.
    My 15yo son went through treatment last year for synchronous testicular and mediastinal GCTs. Nonseminoma, mostly teratoma, some embryonal and yolk sac, 10% each (from the testicular mass). Right orchiectomy, 4x VIP, sternotomy. The residual tumor was necrotic and he's been doing very well since. Chest surgery recovery was a bit rough but teenagers bounce back and he was playing tennis team 3 months later! Blood markers were on the low side to begin with and were normalized since round 1, HCG and AFP always <2.

    Here's my question. During treatment the neulasta shots recovered the WBCs nicely. He needed one transfusion a few weeks after round 4 not surprisingly. Since surgery last May his CBCs have remained on the low side, particularly the total WBCs and platelets. I am a scientist and through literature searches can find little information on long term effects on bone marrow recovery. Since his ANC is normal (neutrophils in WBC are high, leukocytes are low) and he is not anemic the doctors say they will just keep watching every few months.
    My question is for anyone who may have experience with slow recovery in this area and if it ever fully recovers?
    3.1 WBC (low)
    5.37 RBC (normal)
    15% hemoglobin (normal)
    130 platelets (low)
    ANC 2000 (normal)


  • #2
    I had 3xBEP; different regimen, but I had Neupogen on two of the cycles and my ANC was near zero on all three cycles. At the start of chemo my WBC was 2 points over the upper normal level.

    My WBC took a year after chemo just to get back to the lower end of the normal range. During that year they just kept rising steadily, but with a few minor dips along the way; the trend was always a steady rise. Even now (4.5 years later) my WBC is only 2 points above the low end. My Oncologist was never worried about my WBC or ANC in that long as it maintained a steady climb up.

    You don't mention when he completed chemo last year, but if it's less than 12 months, and it's steadily rising, then I don't think that I would worry. With normal ANC and even below normal WBCs, he still has an effective immune system.

    - Matt
    March 4th 2014: [AFP = 2.5; bHCG = 6; LDH = 618]
    March 13th: Left IO 100% Classic Seminoma
    6.3 x 5.1 x 3.8 cm, no invasion of anything
    LDH never fully normalized
    Stage: IS
    Watchful Waiting
    May 1st: promoted to Stage IIB with two PET active tumors in the para-aortic lymph nodes 2.5 & 2.4 cm
    May 12th: started 3xBEP
    Neupogen during Cycle 2 and 3
    July 8th: Last Bleo shot of Cycle 3 -- chemo completed !
    August 4th: Post Chemo CT/PET scan
    September 4th: Port removed
    Jan 9th 2019: 4.5 YEARS ALL CLEAR !


    • #3
      My recent CBC results:
      WBC 5.1 range 4.0-11.0
      RBC 5.56 4.40-6.00
      Hemogloben 14.7 13.5-18.0
      Platlets 195 150-400

      That is almost 9 years post chemo. While the numbers have fluctuated up & down a bit over the years, they have always stayed near the lower end of the range.
      Jan, 1975: Right I/O, followed by RPLND
      Dec, 2009: Left I/O, followed by 3xBEP


      • #4
        Thanks Matt and Davenet! He finished chemo mid-April last year so 9 months. At the end of April and during surgery he had 2 transfusions including platelets so that boosted the counts temporarily. RBC bounced back right away but WBC and platelets have been below normal. WBC may be very slowly rising but only 3.1 now, platelets fluctuate between 125-160 so they come back "low" if under 150. We'll check again in 2 months. It's the only thing that is not "normal" after this long terrible adventure.

        It is very helpful to know that yours came back but that it took a year. There is little information out there on this!


        • #5
          Keep in mind that chemo targets any fast growing cells that take up nutrients in large numbers, not just cancer cells. That's why we lose hair, & blood cell counts drop. All cels that reproduce quickly take a big hit. I have no idea how they tread the fine line between killing the cancer cells & leaving enough of the non-cancer fast cells to regenerate the system, but seems like they figured it out for TC for the most part. However, it's reasonable to expect some sort of long term hit on some of them. I'd love to see some of my noumbers closer to mid-point, but so far i haven't had any noticeable problems yet, seems unlikely I will see any now.

          Jan, 1975: Right I/O, followed by RPLND
          Dec, 2009: Left I/O, followed by 3xBEP