Elevation after surgery may be normal response to stress. http://jem.rupress.org/content/210/7/1283.full

My lymphocytes have run low for years before and after BC. This puts my ratio consistently between 4 and 4.5.

I suspect for some of us that our outlier ratios are "normal" for us and not indicative of disease. At least let's hope so.

It is normal for the neutrophils to makeup the larger cell population over lymphocytes in a white cell count (WBC). Neutrophils are the most abundant white cell population in a healthy person.

http://emedicine.medscape.com/article/2085133-over...

https://labtestsonline.org/understanding/analytes/...

http://www.healthline.com/health/blood-differentia...

http://www.ncbi.nlm.nih.gov/pubmed/24856767

(Turkey tail mushroom)

My MO has been telling me my lymphocytes are low, but doesn't say what I should do about it, nor whether that is good or bad.

I checked my labs and saw another way the ratio could rise. This happened last year around this time: my neutrophils skyrocketed to 5 and lymphocytes tanked to 0.005 due to tissue trauma from injury (thanks cp418 for that link!). Definitely not good. My counts have since recovered and the ratio is now below 1 instead of 1,000!

An increase in eosinophils may be seen with allergies as in the spring/fall allergy seasons.

Many years ago when I was a Medical Technologist we did all these CBC counts manually under a microscope (now all automated). We were taught back then about the shifts in the different white cell populations for a particular medical condition. The basics being that segmented white cells were neutrophils, eosinophils and basophils with the major cell population being neutrophils. The neutrophils were associated with a phagocytic role to respond to an infection (bacteria, stress) and you would see a spike (increase) in this cell type. So if someone had pneumonia of the bacteria type (pneumococcal - confirmed in a sputum sample) they would have a spike in neutrophils to fight this infection. A broken leg or during child birth an increase may occur as the body responds to stress or injury.

The lymphocytes were associated with an immune response of B and T cell types to respond by producing antibodies as in viral infections. So if a person had a viral infection you would see a shift in the total WBCs to see many lymphocytes. The text book example is mononucleosis where you will see a higher population in some patients for this viral infection.

I want to say I'm not an medical expert and so much research has been done to understand the complex role and immune response to these various white cell types. These were the basics back then and we are learning more. TONS of research has occurred and is ongoing to understand the immune response to cancer and try to create new vaccine therapies. ALL NEW. The research in this article is new and we should never jump to conclusions.

To add--this article does not talk about another important ratio (yet another reason not to jump to conclusions), TILs:

Tumor infiltrating lymphocytes (TILs) are a type of white blood cell found in tumors. TILs are implicated in killing tumor cells, and the presence of lymphocytes in tumors is often associated with better clinical outcomes.^[1][2]

http://www.esmo.org/Conferences/Past-Conferences/E...

mamabear0, I've had several studies send me into a panic too but with time, I've learned to filter out and take action that's appropriate for me (that's how I deal with your number #2 above). We each are different as is each of our breast cancers. Sending you hugs! Do what is best for you

Hi everyone - I have no time to post much now but do a name search on me. And read my posts on the "unexplained weight gain" thread. I have been manipulating my neutrophils since my diagnosis and intentionally lowered my NLR in the process. I will post more later. I used to be concerned (when I did not know what was causing it) but now I am just grateful that I found a way to do it after reading all these research papers (High NLR is important for many types of cancer).

More later..

Based on my Onco DX and benefit from chemo, 12% distant recurrence in 15 years looks good to me. Mine is 12% in 10 years. Maybe that is why my ratio is 4-4.5.

I too am very concerned about this information. I had my six month follow up imaging including ultrasound in January along with all the standard blood work. When I asked my BS about the blood test results he said everything was fine. Well the ultrasound showed five solid masses in my right breast. The 3D digital mammogram found an asymmetric focal density as well as a small rounded mass. The mammogram findings are new findings in about 9 months from my last mammogram. I had two of the solid masses biopsies with core needle and results came back with a variety of benign findings. I sent the pathology on to MD Anderson for a second opinion and they also identified columnar cell change. I had an MRI in March and it came back perfectly normal. Went back to my BS last week and requested spot compressions and magnification view on the two new areas that showed up on the mammogram. That was followed by ultrasound which showed the two masses had increased in size. I am scheduled for two excisional biopsies on Tuesday.

When I was at the Dr's office on Wednesday I asked for a copy of my blood work. The first thing I noticed was that my lymphocytes were below normal at .8. My neutrophils have also dramatically increased and my ratio is over 9.

I am very concerned. I went back and looked at previous CBC reports and my ratios were below 3 in 2012 and 2014. In November of 2015 my ratio was up over 5 and in January my ratio was over 9. I did call my internist's office and shared my concerns. I had a CBC on Friday and am waiting to get the results.

I appreciate all the great information shared on this board on this topic.

Peace and healing,

Nancy

My white count has always been traditionally low. My doc sometimes exclaims over it but it's been a bit lower than "normal" since chemo.

Does that mean I might have a bit less chance of recurrence?

Hi Kayrem:

I am not sure this study is useful to you having been diagnosed back in 2011. The paper describes a meta-analysis, meaning they searched the scientific literature for prior published studies meeting specific criteria and then looked at combined data to answer some questions of interest. Note the focus on "association of blood NLR (measured pre-treatment)":

"A systematic search of electronic databases was conducted to identify publications exploring the association of blood NLR (measured pre treatment) and overall survival (OS) and disease-free survival (DFS) among patients with breast cancer."

I would have to study the paper in more detail (and possibly the underlying documents) to understand exactly what is meant by measurements taken "pre-treatment" (do they mean prior to surgery? prior to radiation? after surgery and radiation, but prior to initiation of chemotherapy or adjuvant endocrine therapy? or something else?). However, it does not seem relevant your current blood work, long after the conclusion of treatment.

Best,

BarredOwl

http://stm.sciencemag.org/content/8/361/361ra138

Sorry link did not take

Women with a low NLR fared better at each of the subsequent check-ups at 1, 3, 6, 9, 12, and 15 years, with, respectively, 100%, 98.9%, 91.7%, 82.7%, 82.7%, and 82.7% of them free of recurrence.

This compares with comparable figures of 99.4%, 94.3%, 84.5%, 69.2%, 66%, and 51.4% at the same time points in those with a high NLR.

If the NLR ratio is from immediately prior to diagnosis, this means that all these women had active cancer at the time of measurement and the immune environment was not normal (for lack of a better word). Do lower neutrophil or higher lymphocyte numbers mean they're busy fighting micrometastasis somewhere in the body and hence the better long-term prognosis? Or there is something to the ratio itself regardless of the numbers?