Patient's Query
Hello doctor,
I want to have an opinion about my daughter's (8 years old) chemotherapy treatment for B-cell acute lymphoblastic leukemia. I want to know that is it possible to start or continue chemotherapy at very low counts of WBC and WBC differential.
Hello,
Welcome to icliniq.com.
Your child is having B-cell acute lymphoblastic leukemia. In that case, to induce remission, induction chemotherapy should be given to restore normal bone marrow. After induction, maintenance chemotherapy also to be given. Your total count might be low because of chemotherapy but your daughter was having 87 % blast so chemotherapy should be given.
You can investigate further with a molecular study of different translocation which reflects prognosis in case of ALL (acute lymphoblastic leukemia). So consult your hemato-oncologist for examination and under the guidance of the oncologist, chemotherapy should be given. Take care.
Patient's Query
Thank you doctor,
The doctors adopted ALL BFM-95 protocol and administered a total 9 chemos within that span of time. My query is whether it is possible to administer Methotrexate, Vincristine, Daunorubicin and L-asparaginase continuously in spite of low counts of WBC, especially neutrophils. What are the safe levels of WBC count that should be maintained so as to achieve event-free induction? No doubt, chemo has to be given for such cases. The prime objective is to clear all blast cells and to save the patient from any type of infection. Now, my question is how far it is safe to administer chemo at WBC count 400, 300, 100/cumm?
Hello,
Welcome back to icliniq.com.
You are going through a very tough situation for your daughter. Your daughter is having very low WBC count and it is called severe neutropenia. But the decision has to be individualized after clinical correlation. The induction chemotherapy can be completed under strict doctor observation. In neutropenia chance of infection is present. So if any unusual bleeding, prolonged vomiting, fever, etc., occur then infection should be ruled out.
Meanwhile, care can be taken in form of providing nutritious foods like green leafy vegetables and fruits and hand washing should be encouraged. So, if possible and no infection present then chemotherapy can be continued as per my opinion. WBC transfusion can be given to raise neutrophils count but that has to be discussed with your treating doctor and as per need after clinical correlation. Take care.
Patient's Query
Hi doctor,
Thank you so much for the response.
Hello,
Welcome back to icliniq.com.
You are welcome.
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Answered byDr. Goswami Parth Rajendragiri
Medically reviewed byiCliniq medical review team
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