Neutrophils to lymphocytes ratio has emerged as a substitute marker for the ICI drugs efficiency - it usually has to be low for the drug to work, although there are people that get a good response with the high NLR. Basically, for the NLR to be low, the Neutrophils have to be low and lymphocytes have to be high.
If the Neutrophils are high, it is a sign of a high level of an inflammation in the body, some systemic infection etc. Try to treat it, esp. because some of the infections - like the fungal infection (candida) or virals - do not need the antibiotics for their treatment so will not affect the micribiota, or if you need the antibiotics, allow the microbiota restoration period taking some good quality probiotics. In some publications the Neutrophils are considered to be traitors of the immune system in cancer.
If the lymphocytes are low, there is not enough of the immune cells to attack the tumor even if the brakes are released by the ICI drugs. In general, it is hard to increase the lymphocytes number, so some effort should be done to not to cause the re-distribution (i.e. avoid the surgical or other trauma while under the ICI treatment), also there are some diet modification strategies that suppose to have some influence. I will post what I found in the follow ups.
neutrophils to lymphocytes ratio
Re: neutrophils to lymphocytes ratio
As I promised to elaborate more on the lymphocytes and NLR subject in connection to statistically found correlation with ICI drugs efficacy.
I was reading on the subject of ICI drugs efficacy and what was found to correlate with the initial and continued response - lymphocytes and NLR were found to reflect the immune system ability to produce the robust immune response after the breaks are released by the ICI (Keytruda, Opdivo, atezolizumab). It was implicated in many articles that the initial lymphocytes has to be norm at the start to get an initial response and to continue be norm or recover from the lows during the treatment to sustain the response. Plus the NLR has to be lower than 5 or 4.
So I started to watch Ivan's absolute lymphocytes and neutrophils count and calculate the neutrophils-to-lymphocytes ratio (NLR). Jul 27, 2017 blood work was used as a control well before Keytruda started end of Dec.2017.
Pretty soon I noticed that the lymphocytes count was slowly declining since Ivan started Keytruda and in June it hit the lower normal. The L normal values are 1-4 10*9 L
Plus the NLR was slowly rising as a result of the L decline. It was still very far from the limits defined as worrisome but it was on the constant move to rise. I started reading and we modified Ivan's diet a bit in attempt to increase L counts by stimulating their maturation by adding more Zn into his diet - we started in the beginning of July and this is what we got: - the linear increase in the L since we started.
Starting beginning of July 2018 we modified Ivan's diet to include more elemental zinc containing foods - more lean protein like turkey, pumpkin seeds, eggs plus the minimal dose of the zinc chelate 25 mg - 1 pill a day - which is a minimal dose possible - I was worried to over do zn as there are negative consequences too for that. I had the very low expectations that there is going to be any effect from this regimen as from what I read, it is pretty hard to increase the lymphocytes count without the use of the granulocyte colony stimulating factors (G-CSF) - this class of drug is used by the patients on the traditional chemotherapy with the Leukopenia. It stimulates the white cells production by the bone marrow. It works well in that way but it was noted it can also speed up the growth of cancers in some patients.
I am not sure if adding more Zn worked or it is just a coincidence and more lymphocytes are found in the peripheral blood as the tumor load declines - instead of sitting at the tumor borders and inside and eating it. But it makes sense to review your blood work and adjust your diet if there is not enough Zn. The daily recommended dose is 11 mg for adult male and 8 for adult female (https://ods.od.nih.gov/factsheets/Zinc- ... fessional/) and it is a necessary element for maturation of the lymphocytes. It is very important not to overdo Zn.
Food sources https://frida.fooddata.dk/ShowList.php?compid=274
we are trying not to overstimulate the thyroid as Ivan's TSH is pretty low all the time (means the actual hormone is pretty high) and it is a bit of the challenge as most of the food containing high Zn also contain high iodine.
I was reading on the subject of ICI drugs efficacy and what was found to correlate with the initial and continued response - lymphocytes and NLR were found to reflect the immune system ability to produce the robust immune response after the breaks are released by the ICI (Keytruda, Opdivo, atezolizumab). It was implicated in many articles that the initial lymphocytes has to be norm at the start to get an initial response and to continue be norm or recover from the lows during the treatment to sustain the response. Plus the NLR has to be lower than 5 or 4.
So I started to watch Ivan's absolute lymphocytes and neutrophils count and calculate the neutrophils-to-lymphocytes ratio (NLR). Jul 27, 2017 blood work was used as a control well before Keytruda started end of Dec.2017.
Pretty soon I noticed that the lymphocytes count was slowly declining since Ivan started Keytruda and in June it hit the lower normal. The L normal values are 1-4 10*9 L
Plus the NLR was slowly rising as a result of the L decline. It was still very far from the limits defined as worrisome but it was on the constant move to rise. I started reading and we modified Ivan's diet a bit in attempt to increase L counts by stimulating their maturation by adding more Zn into his diet - we started in the beginning of July and this is what we got: - the linear increase in the L since we started.
Code: Select all
Date Jul 27, 2017 (Keytruda started Dec.27, 2017) Feb.19 May 16 June 27 July 18 Aug 18 Aug 29
N 2 1.9 1.8 1.8 1.8 2.1 2
L 1.5 1.3 1.2 1 1.2 1.4 1.6
NLR 1.33 1.31 1.5 1.8 1.5 1.5 1.25Starting beginning of July 2018 we modified Ivan's diet to include more elemental zinc containing foods - more lean protein like turkey, pumpkin seeds, eggs plus the minimal dose of the zinc chelate 25 mg - 1 pill a day - which is a minimal dose possible - I was worried to over do zn as there are negative consequences too for that. I had the very low expectations that there is going to be any effect from this regimen as from what I read, it is pretty hard to increase the lymphocytes count without the use of the granulocyte colony stimulating factors (G-CSF) - this class of drug is used by the patients on the traditional chemotherapy with the Leukopenia. It stimulates the white cells production by the bone marrow. It works well in that way but it was noted it can also speed up the growth of cancers in some patients.
I am not sure if adding more Zn worked or it is just a coincidence and more lymphocytes are found in the peripheral blood as the tumor load declines - instead of sitting at the tumor borders and inside and eating it. But it makes sense to review your blood work and adjust your diet if there is not enough Zn. The daily recommended dose is 11 mg for adult male and 8 for adult female (https://ods.od.nih.gov/factsheets/Zinc- ... fessional/) and it is a necessary element for maturation of the lymphocytes. It is very important not to overdo Zn.
Food sources https://frida.fooddata.dk/ShowList.php?compid=274
we are trying not to overstimulate the thyroid as Ivan's TSH is pretty low all the time (means the actual hormone is pretty high) and it is a bit of the challenge as most of the food containing high Zn also contain high iodine.
Olga