Are these abnormalities related to Aubagio?

Question:
I have been on Aubagio for two years. My WBC's have been slowly declining, and now are low (3.7, NL 3.8) with abs. neutrophils 1828 (NL 1500). Gammaglobulins are 0.5 (NL 0.8), Kappa 129, Lambda 62, KAPPA/LAMBDA ratio 2.08. RBC's showed mild anisocytosis and poikilocytosis. Band and activated lymphocytes present. Are any of these abnormalities related to the Aubagio (besides the WBC's)? Thanks.

Answer:
A low White Blood Count (WBC) on Aubagio is relatively common with long term treatment (15-20 % on the 14 mg dose). Most of the time this is mild, as in your case, and does not require an adjustment in treatment. The most important thing is to make sure your absolute lymphocyte count stays above 500 and absolute neutrophil count stays above 1000 (yours is 1828). 
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The mild anisocytosis and poikilocytosis refers to abnormal size and shape of red blood cells. This can occur with stressed bone marrow, anemia, liver disease and kidney disease among many possible causes. This is usually of no significance but your doctor can let you know if it is significant in your case.

You should definitely have your blood counts monitored more closely than usual and ask your MS specialist if he or she thinks these findings are significant in your case.

Revere (Rip) Kinkel MD
Professor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego