Questions & answers
The questions people ask us, answered with the source attached.
Short answers for a waiting room. Every one links to the study, label, or agency page it came from, so you can hand it to your oncologist or your representative without taking our word for it.
The number
What is the absolute lymphocyte count?
Lymphocytes are the white blood cells that recognize and kill infected or cancerous cells: T cells, B cells and natural killer (NK) cells. The absolute lymphocyte count (ALC) is how many of them are in a microliter of your blood. It is printed on every complete blood count (CBC) with differential, the routine test drawn before nearly every chemotherapy cycle. A common adult range is about 1,000 to 4,800 cells per microliter; Mayo Clinic Laboratories prints 0.95–3.07 × 10⁹/L. Use the range on your own report.
Sources: Cleveland Clinic, Lymphocytes · Mayo Clinic Laboratories, CBC with differentialWhere is it on my lab report?
Look in the CBC with differential for a line labeled "Lymphs Abs," "Absolute Lymphocytes," "Lymphocytes #," or "ALC." It is the absolute number, not the percentage ("Lymphs %"). Units vary: 0.53 K/µL, 0.53 × 10⁹/L and 530 cells/µL are the same count. If you only see a percentage, multiply it by the total white blood cell count (for example, 15% of 3.5 K/µL = 0.525 K/µL = 525 cells/µL). The ALC card page has a checker that converts the units for you.
Source: Mayo Clinic Laboratories, test components and unitsWhat counts as low?
Below 1,000 cells/µL is lymphopenia in adults. Many cited studies used the NCI's historical CTCAE v5.0 scale: grade 1 is below the lab's lower limit down to 800; grade 2 is 500–799; grade 3 is 200–499; grade 4 is under 200. Grades 3 and 4 are what most of the survival studies call "severe." Beth's count of 525 was grade 2 under v5.0, above the grade-3 cutoff of less than 500. CTCAE v6.0 uses different lymphopenia grading.
Sources: Cleveland Clinic, Lymphopenia · NCI CTCAE v5.0, "Lymphocyte count decreased"Isn't this the same as my white blood cell count, or the neutrophil count they already watch?
No. The white blood cell count is the total of several cell types. Neutrophils (the ANC) are the ones oncology already monitors closely, because a low ANC can increase infection risk and G-CSF is used in appropriate patients; NCCN and ASCO guidelines are built around it. Lymphocytes are a different population, they recover far more slowly, and some treatments, such as temozolomide, have lymphopenia monitoring and infection-prevention requirements. That does not establish a universal threshold for lymphocyte-restoring treatment. A normal ANC and a low ALC on the same report is common, and both results deserve interpretation in the clinical context.
Sources: NCCN, Hematopoietic Growth Factors · ASCO/IDSA, Fever and Neutropenia, JCO 2018 · Ménétrier-Caux et al., JITC 2019Does checking it cost anything extra?
No new test is needed. The absolute lymphocyte count is already a line on the CBC with differential (CPT 85025), which Medicare pays about $7.77 for nationally. Asking for the number to be read and recorded costs nothing.
Source: Medicare Clinical Laboratory Fee Schedule, CPT 85025Why it matters
Why does a low count matter if my scans are clear?
Because the lymphocytes are the part of you that finds the cells the scan cannot see. In 297 patients with glioma, pancreatic or lung cancer, counts fell 63% within two months of chemoradiation; 43% reached grade 3–4, and those patients had twice the hazard of death (HR 2.1). Across 802 patients with lymphoma, breast and sarcoma, baseline lymphopenia independently predicted shorter survival in every group. The same signal appears in 20-study and 9-study meta-analyses of radiation-induced lymphopenia. Scans and blood counts provide different information. ALC alone cannot predict an individual's outcome or prove how effectively their immune system fights cancer.
Sources: Grossman et al., JNCCN 2015 · Ray-Coquard et al., Cancer Research 2009 · Damen et al., IJROBP 2021 · Venkatesulu et al., Future Oncology 2022Does the count come back on its own after treatment?
Slowly, and often not all the way. A 2025 review of 142 curves from 52 publications found a median count of 24% of baseline after intracorporeal radiotherapy. Recovery data from 34 studies showed a median of 55% of baseline within one year. After chemotherapy, CD4 T cells were still at 60% of baseline at nine months in one breast cancer study. On FOLFOX, the regimen Beth received, 42.8% of colorectal patients became lymphopenic, and a nadir below 0.66 × 10⁹/L was associated with poorer disease-free survival (HR 3.52).
Sources: Sandul et al., Clin Transl Radiat Oncol 2025 · Verma et al., Breast Cancer Research 2016 · Hong et al., BMC Cancer 2013I'm on immunotherapy. Does the count matter for that?
Checkpoint inhibitors work by releasing the brakes on T cells; if there are few T cells, there is less to release. In 10,498 propensity-matched patients, a baseline count under 1.5 × 10⁹/L was associated with 24-month survival of 27.9% versus 35.3%. In 179 patients, becoming lymphopenic three months into immunotherapy was associated with lower median survival, from 18.3 to 9.8 months. The authors of the larger study recommend adding the baseline ALC to routine pre-immunotherapy assessment.
Sources: Ismail et al., Cancers 2026 · Conroy et al., BJC Reports 2024 · Goldschmidt et al., Cancer Medicine 2023If it matters this much, why isn't it in the guidelines?
We asked the same question. NCCN's growth-factor guideline and the ASCO/IDSA neutropenia guideline set thresholds for neutrophils, platelets and hemoglobin, and none for lymphocytes. A 2019 review put it plainly: the lymphocyte count is "rarely analyzed and never used to choose therapy or as prognostic criteria." That review describes practice at the time, not every current treatment protocol. Drug-specific lymphopenia monitoring and infection-prevention instructions exist; proven strategies to restore lymphocytes and improve survival across solid tumors remain under study. That is the gap this site, and the policy asks, are about.
Sources: NCCN Guidelines · Griffiths et al., JNCCN 2022 · Ménétrier-Caux et al., JITC 2019Is this only about cancer?
No. In 31,178 U.S. adults in the NHANES cohort, a count at or below 1,000 was associated with higher all-cause mortality (age- and sex-adjusted HR 1.8). In 98,344 Danes, lymphopenia was associated with higher infection-related mortality (HR 1.70). In sepsis and in COVID-19, persistent lymphopenia tracked with the worst outcomes. This site focuses on cancer care; these observational associations do not establish that raising the count prevents death.
Sources: Zidar et al., JAMA Network Open 2019 · Warny et al., PLoS Medicine 2018 · Drewry et al., Shock 2014Anktiva
What is Anktiva?
Anktiva (nogapendekin alfa inbakicept-pmln, formerly N-803 and ALT-803) is an engineered version of interleukin-15, a signal the body uses to make natural killer cells and CD8 T cells and to keep them alive. In a phase 1 solid-tumor trial, NK cells expanded and CD8 T cells showed early activation, but circulating CD8 counts increased only modestly. One of seven evaluable patients had an increase in regulatory T cells. There were no objective tumor responses in this small trial. It is made by ImmunityBio. Our Anktiva page has an animation of the mechanism and a numbered list of the primary documents.
Sources: Margolin et al., Clinical Cancer Research 2018 · Prescribing information, DailyMedIs Anktiva FDA-approved?
Yes, for one use. On April 22, 2024 the FDA approved it with BCG for adults with BCG-unresponsive non-muscle-invasive bladder cancer with carcinoma in situ, given into the bladder. In that trial 62% had a complete response, and 58% of those responses lasted at least a year. It is not approved for any other cancer or for treating a low lymphocyte count.
Sources: FDA approval notice, April 22, 2024 · Chamie et al., NEJM Evidence 2023So is it approved to fix a low lymphocyte count?
No. Using Anktiva to reverse lymphopenia is investigational. It is available two ways: through an FDA-authorized expanded-access program (announced June 2025) for people with relapsed or refractory solid tumors and a count below 1,000, and through clinical trials where eligible. NCT06956547 is the expanded-access protocol, not a conventional clinical trial. Expanded access lets a doctor use an unapproved treatment outside a trial; it is not approval and does not by itself prove the treatment works. Most of the lymphopenia data so far comes from the company and from single-arm studies, and on March 13, 2026 the FDA sent the manufacturer a warning letter about promotional claims. We say all of this on every page that mentions the drug.
Sources: ClinicalTrials.gov NCT06956547 · Reagan-Udall Expanded Access Navigator listing · FDA warning letter, March 13, 2026How do I ask my oncologist about it?
Bring two numbers: your latest absolute lymphocyte count and your pre-treatment baseline if you have one. Then ask one sentence: "My count is below 1,000. Am I eligible for the Anktiva expanded-access program for lymphopenia, or a trial that restores lymphocytes?" The expanded-access protocol is run through the Chan Soon-Shiong Institute for Medicine in El Segundo, California; your oncologist can request it on your behalf. The FDA's expanded-access page explains the process for physicians. Print the wallet card and hand it over; the clinician page has the literature they will want to see.
Sources: CSSIFM, lymphopenia program · FDA, Expanded Access contact informationWhat are the side effects?
For the approved bladder-cancer use, the label lists the most common reactions (15% or more, including lab abnormalities) as increased creatinine, painful urination, blood in the urine, urinary frequency and urgency, urinary tract infection, increased potassium, musculoskeletal pain, chills and fever. In the phase 1 solid-tumor trial, the most common effects of subcutaneous dosing were injection-site reactions and flu-like symptoms. Safety in the lymphopenia setting is still being studied; that is exactly why the expanded-access program and the trials exist. Read the full prescribing information and discuss it with your own care team.
Sources: Anktiva prescribing information, DailyMed · Margolin et al., Clinical Cancer Research 2018Beth & the film
What happened to Beth's count?
Beth Kompothecras had a clean colonoscopy in 2021. In March 2023 her hemoglobin was 2.5; a colonoscopy on April 25, 2023 found stage 3 colon cancer, and on May 1, 2023 surgeons removed 24 inches of colon and 44 lymph nodes, one positive. She had six cycles of FOLFOX from June to September 2023. In January 2026, with clear scans, her absolute lymphocyte count was 525. In February 2026, after her first Anktiva injection at the Chan Soon-Shiong Institute for Medicine, it was 1,400. After ten injections over twenty weeks, in July 2026, it was 1,131, inside the 850–3,900 range on her report. One patient is a story, not a trial, and we say so; the trials are listed on the Anktiva page.
Sources: Statement from Dr. Gary and Beth Kompothecras · Killing Cancer, Beth's chapter · lab reports held by the familyWhat is "Killing Cancer"?
A presentation built from the testimony of five patients treated with Anktiva (Justin, Lisa, Valerie, Andrew and Alan) plus Beth's own account and a statement from Dr. Gary, narrated and cut into a ten-minute Editor's Cut that opens the home page. The full chaptered version runs longer and includes each interview with its source. It was made for Secretary Kennedy and his policy staff, and for anyone in treatment who has never been told their number.
Sources: Killing Cancer presentation · One-page brief (PDF)This site
Who runs LymphocyteCount.org, and who pays for it?
Dr. Gary Kompothecras and Beth Kompothecras of Sarasota, Florida, with help from their family. It is self-funded. It carries no advertising, sells no data, and has received no money, review or approval from any pharmaceutical company, including the maker of Anktiva. Where we cite company-reported results we mark them as such and keep them separate from peer-reviewed work. The About page has the full methodology and privacy statement.
Source: About this siteIs this medical advice?
No. It is educational information with its sources attached, written so that you can have a better conversation with the people who are treating you. Do not change any treatment based on this site. Bring the number, and the question, to your own care team.
Source: How we reviewWhat can I do in five minutes?
Four things. Print the ALC card and hand it to your oncologist. Send the pre-written letter to HHS and the FDA asking that the count be read and recorded. Tell us your story if your count was low and nobody mentioned it. Share the film with one person in treatment and one person who sets policy.
Source: The three policy asksI found an error. What do I do?
Tell us, please. Every content page shows the date it was last reviewed. Corrections, missed studies and guidelines we did not find go to info@lymphocytecount.org or the contact form; we fix errors on the page and note the change on the About page.
Source: How we review