Disclaimer: To protect patient privacy, this question has been edited slightly to omit identifying details.
A Patient Power user recently asked: “I have been taking acalabrutinib (Calquence) since December 2021. I have taken every COVID vaccine (5 in all) available to me, the last of which was in September 2022. In early November of that same year, I caught COVID. My primary doctor put me on Paxlovid for five days. In the middle of that treatment, I started in with a urinary tract infection (UTI). I have since been on three separate antibiotics before symptoms finally subsided. I’ve been sick so much!
Because my Calquence slowly lowers my white blood cells (WBC), my immune panel now is low. Will my immune system become normal once my WBC is normal, or will continued immunotherapy drugs keep my immunity low?”
Expert Response
Your immune system is a complex process, and you may want to “have a sit down with your physician” to discuss “the relationship of ‘immunity’ to your WBC count,” said Kerry Rogers, MD, from The Ohio State University Comprehensive Cancer Center – The James.
“In people with chronic lymphocytic leukemia (CLL), the immune system does not become ‘normal’ when the WBC count is normal,” Dr. Rogers said. “The immune system is very complex and includes multiple types of WBCs (neutrophils, lymphocytes, monocytes). The immune function is not just based on the number of all these different types of cells but also how well they are working or functioning, which is not something we can test.”
“There are also parts of the immune system that are not captured by looking at the number of WBCs, such as immune globulin (e.g., IgG levels),” Dr. Rogers pointed out.
“In people with CLL, even when the CLL is in remission, on- or off-treatment, the immune system is still compromised. CLL is a lifelong immune compromising condition,” Dr. Rogers said. “How to live as well as possible with CLL is different for each person and should be discussed with [your] physician.”
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