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Pls help : Spleen : discomfort

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Hi all/Sandy/David/Scuba

When i was dx with cml - i had spleen size of 22 cm with wbc count 215000. I did not have any discomfort.

However, after starting off with tasigna the first 6 weeks were good. Since 7th week (15 Feb) i started to feel discomfort below my left rib cage where spleen resides.

I had an ultrasound and chest x-ray on 22nd Feb - everything was fine. Spleen size was at 14.4 cm.

I am till today feeling that discomfort. My hb/platelets and counts are at normal range 7700 (3 march).

I am worried if my spleen started to enlarge again.

Kindly suggest.

Looking for suggestions. Kindly help.

My oncologist always asks me and palpates my abdomen for enlarged spleen . You need have someone check this. I know it’s a side effect of Gleevec not sure about other TKI’s.

Hi there,

It would be very unusual for your spleen to increase in size when you are responding to your medication. Your doctor will know that you are responding by looking at your blood test results.

I know this isn't very scientific, but if your spleen has shrunk (which it will have) it's not totally outside the realms of possibility that the disruption caused by that could feel painful. Most of us who have big spleens at diagnosis have pain at that point, so I suppose wouldn't really notice the sort of "spleen reduction" pain you are having as it would be continuous from the pain of the big spleen.

Please bear in mind that the above is just a thought and not backed up with any personal experience or data. If your pain persists it's definitely worth getting your spleen looked at again. A quick ultrasound can check the size, and can sometimes just a hand on the abdomen. 

Perhaps others here have had experience of a sore spleen area upon reduction?

David.

David,

I almost have same symtoms of enlarged spleen. Worried if nilotinib isnt working for me.

The discomfort started off 20 days back. Since then i have been watching the wbc counts.

17th Feb - 4700
23rd feb - 5900
03 Mar - 7700
Today - 8900

I see a increasing trend. Is this normal?

You are seeing an increasing trend that is within the normal range. Often TKIs can whack your system quite hard, bringing your blood levels lower than they should be. The term for this is myelosuppression, and it's quite possible that this is caused by nilotinib. 4700, for example, is right at the low end of normal. 11,000 would be at the upper end.

So I would say it's important to keep an eye on those counts, but if they start to plateau below 11,000 (or even a little above) then that is not a problem at all. It's just your body returning to its normal ways and blood production. But do keep an eye in case they continue to climb.

David.

Sure. I will keep counts watching. One more thing i noticided is absolute neutrophill count.

ANC was 2.56 on 3rd march
Today it is 4.52.

Is this normal?

Normal range for neutrophils is between 2 and 7.5, so both are in range. What was time between these readings? It may well be your WBC and neutrophils were lowered (myelosuppression as David talked about above)  when you started taking your TKI, but your system is now establishing a new normal. 

ANC was always in the range of 2.5 since i started nilotnib. Almost 65 days now. Todays report shows increase to 4.52 for the first time.

Don't see the blood reports..immediately report to a Hameotologist...anything extramedullary is not a good sign...