BETA - What are cytopenias? What myeloma treatments are known to lower blood counts?

What are cytopenias? What myeloma treatments are known to lower blood counts? So cytopenia means the cell components in the blood are low. Very simple. So the blood has three main components. First one are the white cells. Those cells protect us from infections and they have many other subtypes. The second component is the red cells. Those are the ones that carry oxygen. And the third one are fragments of cells. We call them platelets and they help us to protect us from bleeding. Very simple overview. If those three are down, we call it cytopenia. If all three are down, we call it pancytopenia. Means a medical term that everything is down. Now for hematological cancers, for hematology in general, pancytopenia is very common. All hematologists are very comfortable dealing or managing pancytopenia. Some treatments, especially the new ones for multiple myeloma, are mostly immune therapies. They still cause cytopenias, but most of them don't cause pancytopenia. So what are the treatments that can cause more pancytopenia than the others? First thing that comes to mind is stem cell transplants. Malfolin is the first drug approved for multiple myeloma and the best drug so far. I hope some other drugs will be able to beat it because of the side effects that it has. But one of those side effects is pancytopenia. Patients after transplant, they require a lot of support, blood transfusions, platelet transfusions, to get them through that period. And most of the time it takes a few months down the road for those pancytopenias to resolve. The second most common one is the new treatments, the CAR-T treatments. With the immune therapies and more with the CAR-T because we use lympho-depleting chemotherapy, which is a fancy term for large doses of chemotherapy to kill the old lymphocytes before we give the new trained lymphocytes so they can have a space to grow. Whenever we use large doses of chemotherapies, we get pancytopenia. But more important in those new treatments is the lympho-depletion component of it. We have a subtype of cells called CD4 cells. Those cells get depleted and lymphocytes help us fight infections. After the new fancy treatments for gut approved, we see a lot of those patients who are getting those treatments have very low CD4 counts. What does that mean? That means those patients are at risk for apportionistic infections. Germs fly in the air. Every day we ingest those, we exhale them, they don't cause problems. In patients who are getting immune therapy, this type of immune therapy, they must get prophylaxis because those germs can go inside the lungs and they actually can cause infection. So I believe all hematologists feel comfortable giving the prophylaxis, which could be Bactrim, Bentamidine, whichever method they choose. Bactrim is stronger. But it's important to be cognizant about this fact that the lymphocytes are low and we have to support patients. Most patients, after we stop treatment or we give treatment holidays, their counts will recover. Regarding blood and platelets, we have hormones that could help increase both. And we can do transfusions if needed. Blood is composed of three different components. So white blood cells, red blood cells, and platelets. A lot of the treatments that we use in multiple myeloma or for the matter even different types of cancers, they can, in the process of killing the cancer cells, sometimes also affect the good cells that make these normal types of blood cells. And that's what causes low white blood cell count or low hemoglobin or anemia or low platelet count. And that's what we refer to as cytopenia. So when you have low white blood cell count, it's referred to as leukopenia or neutropenia, where we're looking at the number of neutrophils, which are the body's defense mechanism or the soldiers, if you want, to protect the body against different types of infections. So when neutrophils are low, we call it neutropenia. When the hemoglobin is low, that's what carries oxygen around the body and distributes oxygen to different tissues. And when your hemoglobin is low, we call it anemia. And then when your platelet count is low, platelets usually help in controlling bleeding. So whenever you have a cut on your finger or so from some activity that you're doing, and you would bleed for a little bit, but then you automatically stop bleeding. And that's the body's platelets making a plug, if you were to stop the bleeding. And so whenever the platelets get low, we call it thrombocytopenia. So this is what cytopenias mean. So frequently, whenever you go to your doctor's office, and especially if you're on treatment, you would be getting blood draws. And so we commonly do a test called CBC, or that is the complete blood count. And usually that has all of these values, where they'll tell you the white blood cell count, the different types of white blood cells, that is the neutrophils, basophils, eosinophils. So there are all these different monocytes, so there are different types of white blood cells. So it will even tell you that. And then it will tell you your hemoglobin level and the platelet count. So it's all part of this test called the CBC, which is from the blood that is drawn at your doctor's office. Typically, if the counts are just somewhat lower, mildly decreased, they don't cause a lot of problems. And so your doctor can tell you when your counts are mildly decreased, or moderately decreased, or severely decreased. And usually when your counts are severely decreased, that puts you at some risk. Say if your white blood cell counts are really low and your neutrophil count is less than 500, then it puts you at an increase of getting infections. The way to increase your white blood cell counts is to give you a growth factor shot, like granics, or commonly called neupogen or neulaster. You may have heard of this, depending on what regimen you use. But it's a growth factor that stimulates your body to make more white blood cells. So that can be done if your counts are severely low. If your hemoglobin is low, usually the common practice is to use a blood transfusion, blood cell transfusion. If your hemoglobin is below seven, or if you have some sort of heart disease, then below eight. Or if you're really symptomatic from the anemia, so now symptoms of anemia would be feeling really tired, not having the energy to do the things that you would usually be able to do, or feeling lightheaded sometimes, or dizzy, feeling short of breath on exertion. So those are some symptoms. Or having pale color discoloration in your eyes, or your hands are looking really pale, or your lips are really pale. So those are all signs of anemia and signs and symptoms of anemia. And so when you are at a really low level of hemoglobin, your doctor may advise you to get a patented blood cell transfusion. And then similarly, if your platelet count is below a certain threshold, usually it is 10,000. It may put you at an increased risk of bleeding, and so your doctor may advise you to get a platelet transfusion to bring the counts up. And usually the treatments that are used in multiple myeloma for induction, they can cause cytopenias, but a very, I would say a small percentage of patients actually go on to the point that they require transfusions. But that is an option.