Immunotherapy and elevated EOs (eosinophils WBC)

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This topic contains 7 replies, has 3 voices, and was last updated by  cindy121 2 weeks, 2 days ago.

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July 25, 2017 at 4:47 pm  #1291130    

cindy121

Has anyone heard of or had the experience of eosinophil white blood cells ending up with toxicity of “attacking” lungs, nervous system, heart or skin? I’m up over 21% not explainable by allergy, infection or parasite. Hypereosinophilia?

July 25, 2017 at 7:51 pm  #1291131    
JimC Forum Moderator
JimC Forum Moderator

Hi Cindy,

Lung cancer-related eosinophilia appears to be an uncommon complication, but it’s not well understood and occurs in situations in which immunotherapy is not being used, so it would be difficult to know whether the immunotherapy plays a role. You can read about the limited information available about the connection between eosinophils and cancer here. Keeping in mind that this is an unusual phenomena, there is a case study describing severe eosinophilia in a lung cancer patient here.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

July 26, 2017 at 5:59 am  #1291132    
JimC Forum Moderator
JimC Forum Moderator

I should also add that I have been unable to find any case discussions of patients whose eosinophilia was thought to be caused by immunotherapy. That doesn’t mean that it’s not possible or it’s not happening on occasion, since these current immunotherapies for lung cancer are still relatively new.

Also, as you may be aware, eosinophilia can have many causes, many of which are listed on this page from the Mayo Clinic: http://www.mayoclinic.org/symptoms/eosinophilia/basics/causes/SYM-20050752

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

July 26, 2017 at 1:26 pm  #1291133    

cindy121

Thank you, Jim, for your prompt attention to my inquiry. I had consulted the Mayo Clinic website. It tends to have answers to many of my questions. My oncologist is on vacation, but I did speak with a different one from my cancer center today. I am not panicking that I’m in any imminent danger of a fast and/or serious complication, but I am still puzzled because I am still mildly concerned and like to understand the chemistry/biology of side effects of the “phase IV” trial those of us on immunotherapy are on.

I was told that, basically, there’s no need to worry about my EO -EOSINOPHIL percentage being high because my “absolute eosinophil” count is normal. ????? That’s just counterintuitive to me that the same blood sample would indicate contradictory results. Yes, your percentage of WBCs that are eosinophils is almost 6 times what it should be, but the number of them (per however much blood measurement) is normal. This oncologist did say stop treatment until my own doctor is back from vacation.

Can someone clarify this “detail”? Thanks. Cindy

July 26, 2017 at 4:45 pm  #1291134    
JimC Forum Moderator
JimC Forum Moderator

Hi Cindy,

The eosinophil percentage is the percentage of white blood cells that are eosinophils, while absolute eosinophils represent the percentage of eosinophils multiplied by the total white blood count. That provides a value for the total number of eosinophils in the blood, which is seen as more significant than the percentage.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

August 5, 2017 at 8:45 am  #1291189    

cindy121

Thank you again, Jim. I do understand the difference between the absolute number of eosinophils and the percentage. My overall WBC is stilll normal and absolute eosinophils is normal, but this week, the eosinophil percentage went up another 7-8% to 32%. I’m just really still not comfortable with the test results listing the normal percentage as 1-4%, but hearing “don’t worry about” 32%! That’s not just slightly above normal! I would like to know what the possible, eventually indications are for this vast discrepancy. Now my neutrophils are going below normal, so having thosewbcs continue to go further out of proportion has to mean something. no allergies or infection or parasite that I know of. In fact, so symptoms at all, but if my immunotherapy is causing it and the consequences are asymptomatic, shouldn’t the drug company at least be familiar with this as a risk and offer some idea as to how a patient would know that.healthy tissue is being “attacked”? BMS says they’re there for patients, but all they want to do is collect information, not share or help.

August 6, 2017 at 1:16 pm  #1291196    
catdander forum moderator
catdander forum moderator

A new study suggests a rising white blood cell count during immunotherapy treatment corresponds to efficacy. So this may be a good thing. I’m keeping my fingers crossed.

“A greater number and concentration of natural killer cells at baseline was associated with response to nivolumab, as was an increase in the number of natural killer cells during treatment. Responders to nivolumab also had a greater number and concentration of CD8 positive T cells that expressed PD-1.” https://www.sciencedaily.com/releases/2017/05/170504185213.htm

Janine

August 6, 2017 at 3:37 pm  #1291197    

cindy121

Hi, Janine,

Thank you for taking the time to respond and post that. I had also seen that study. At the time, I had just checked back to my baseline total WBC and it wasn’t fabulous and it hasn’t increased much during treatment. But now that I notice both the words “number” and “concentration”, that’s a bit closer to my dilemma with the 5 different kinds of WBCs; their “absolute” number and “percentage”. In my case my eosinophils number is lower and my “concentration” is sky high. I’m sure there all have a slightly different function, which I have read on Mayoclinic.org and understand intellectually. But there has be a reason why there are “normal values” of both for us to see and (try to) apply to our own blood work. There must be something I should be watching for if ANY blood test is eight- thirty two (8-32 times the normal level). I just don’t want it to be an emergency whenI finally find out what does occur. If anybody has an extra 30 seconds with their hematologist/oncologist, maybe you could get me a second opinion to, “What should a patient be aware of if their eosinophil percentage goes up to 32%?” I don’t get it, but thank you for the link. I’ll read it again.

Cindy

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