What is neutropenia? When during my treatment am I likely to experience neutropenia? What can be done to increase my neutrophils?

What is Neutropenia? Neutropenia is a low level of neutrophils. So neutrophils are a type of white blood cell. So again, AML is a disorder of white blood cells. It's a disorder of the white blood cells within the myeloid lineage, which is a way we produce white blood cells in our bone marrow. So neutropenia is considered a level that's below 1,500 cells per microliter. Typically there is a range of neutropenia. So you can have extreme neutropenia where you have a very low level of these cells called neutrophils or you can have a moderate level of neutropenia or you can have a mild neutropenia. So the range is pretty broad, but neutropenia is just a definition that we can actually look for when we analyze your blood with a complete blood count. Some laboratories have different cutoffs, but it's usually below the anticipated cutoff and that's considered neutropenia. When during my treatment am I likely to experience neutropenia? So when in your treatment are you going to experience neutropenia? It can depend based on what treatment you're receiving and your response to the treatment, but typically for patients who are younger and considered generally fit or who have a very good performance status, we generally start with induction chemotherapy. And again, a lot of this can depend on provider and different regimens used at different places, but typically within 7 to 10 days after you receive the chemotherapy should you begin to have a lowering of your white blood cell count. So again, it can depend on the therapy and it can depend on the time course of when you receive the therapy. Because of the advances in AML, there are just a plethora of new treatments available. So some of the targeted therapies may not cause neutropenia to the extent previously seen with chemotherapy. So it really depends, but typically if we're going to consider chemotherapy, it's usually around 7 to 10 days after starting therapy. The typical time that patients may experience neutropenia would be, it tends to be usually the week after chemotherapy is completed. So there is a delayed effect. Usually on initial diagnosis, a patient may be neutropenic. So there's a couple different times where we do see it frequently, oftentimes initial diagnosis and then also the week or so after chemotherapy. Depending on the regimen of the therapy, some patients may have a prolonged neutropenia, which puts them at very high risk for infections, which we typically will give them antibiotics, antifungals, and antivirals to prevent infection. What can be done to increase my neutrophils? So to increase your neutrophils, you can ask your provider if something called growth factor may be something that would be beneficial. Typically you want to start that when you're in a remission, at least a confirmed remission. But typically the way that works is it increases your white blood cell count, and so that can help with recovery. Again, in leukemia though, the important thing is that you want to give it when you have evidence of remission because you don't want the disease itself to be stimulated by the growth factor. So neutrophil count typically will, as long as the bone marrow is producing the right cells, the bone marrow will increase that neutrophil count on its own after chemotherapy has cleared out of the system. One thing that we can do as physicians is provide growth factor that can help facilitate white blood cell count recovery depending on the patient's current regimen. What are growth factors? There's a list of different names available, but typically the one, the name is GCSF, growth colony stimulating factor. So growth factors are usually injections that we give to help stimulate the white blood cells. Certain regimens, we typically will give them because if the neutropenia is going to be prolonged for more than seven days and it's going to be severe, the risk of infection is high. So typically we'll give growth factor to help prevent infections and again to stimulate the bone marrow cells to help facilitate the white blood cell count recovery.