Aa
ANC drop again while on Neupogen, What's next?
Yesterday I got some more bad news from my doc and I don't know what I should do next, so I'm hoping you guys can give me some advice. I'm on week 24/48 and since week 2 I've had problems with my ANC levels. After my first shot my ANC dropped to 200 (from 2000 before tx), so my peg dose was lowered to 135ml (I was on a reduced dose for 20weeks until my ANC levels stabilized with Neupogen). My doc put me on neupogen and my ANC increased to 1200 so last week he put me back on the full dose of pegasys (180ml). After one shot of pegasys at 180ml my ANC went from 1200 to 300. Now my doc wants to put me on Neupogen twice a week, and I wanted to know if anyone gets two injections of Neupogen a week? Also should I just let the doc decrease the dose back to 135ml and stay on the one dose of Neupogen, or should I try and stay on the full dose with the two shots a week? I'm really scared because I don't want to keep putting more meds in my body, but I don't know what to do. Also to make matters worst, I'm also on 40,000 Procrit and although my Hemoglobin levels were steady at 10 but they are starting to drop. My doc wants to add another 20,000 of Procrit, which would mean another shot and more meds (when it rains it pours). I'm starting to get really fed up with the whole tx and I really don't know what I should do (keep going or just quit). If anyone could offer any advice I would really appreciate it.
WEEK 24/48
GENO: TYPE 1A
VIRAL LOAD PRIOR TO TX: 208,000
WK 11 <10ML
STAGE 0, GRADE 0
WEIGHT: 130 POUNDS
PEG: 180ML (FOR NOW), RIBA 1000MG
HAD VIRUS FOR 7 YEARS
BROOKE
WEEK 24/48
GENO: TYPE 1A
VIRAL LOAD PRIOR TO TX: 208,000
WK 11 <10ML
STAGE 0, GRADE 0
WEIGHT: 130 POUNDS
PEG: 180ML (FOR NOW), RIBA 1000MG
HAD VIRUS FOR 7 YEARS
BROOKE
Brooke, I was interested in the earlier discussion, so I did some reading. You may be interested....
"Relapse is defined as an elevation of HCV viral load following initial suppression. If it occurs, it usually does so within several weeks following completion of interferon alfa therapy, with viral load initially rebounding beyond and then returning to the pretreatment level."
From here:
http://hivinsite.ucsf.edu/InSite?page=md-04-01-32
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Also, remember in the Alessandra Mangia study, 9 of 10 relapsers from a 12 week treatment (genos 2 & 3) achieved SVR by subsequent 24-week treatment. No obvious treatment-enlightened mutations from my point of view. (I gave up trying to find a you a link, but it's out there somewhere - I have it on my hardrive).
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I don't offer this as a suggestion of what you should choose to do, just some info that compliments the viewpoints taken above. Best wishes to you.
"Relapse is defined as an elevation of HCV viral load following initial suppression. If it occurs, it usually does so within several weeks following completion of interferon alfa therapy, with viral load initially rebounding beyond and then returning to the pretreatment level."
From here:
http://hivinsite.ucsf.edu/InSite?page=md-04-01-32
---------------------------------------------------
Also, remember in the Alessandra Mangia study, 9 of 10 relapsers from a 12 week treatment (genos 2 & 3) achieved SVR by subsequent 24-week treatment. No obvious treatment-enlightened mutations from my point of view. (I gave up trying to find a you a link, but it's out there somewhere - I have it on my hardrive).
---------------------------------------------------
I don't offer this as a suggestion of what you should choose to do, just some info that compliments the viewpoints taken above. Best wishes to you.
Actually the Hepatitis C is an RNA virus, which means that it mutates frequently. Once an infection has begun, hepatitis C creates different genetic variations of itself within the body of the person. The mutated forms are frequently different enough from their ancestors that the immune system cannot recognize them. In a recent major breakthrough, three groups have reported the replication of full-length HCV clones in vitro, paving the way for the development of effective antiviral therapies and vaccines. Hopefully this will give all of the Future people who don't even realize they currently have it a better treatment and a vaccine for the ones who don't.
EarthMan
EarthMan
Brook,
There is more involved to just quiting at this stage. Once a person goes on treatment with the current Pegs/Ribavirin and discontinues, the VIRUS MUTATES. It will also make your viral load increase significantly. Please take this into consideration also when evaluating what course of action you are going to take.
This will have an impact on future treatments if you decide to discontinue.
EarthMan
There is more involved to just quiting at this stage. Once a person goes on treatment with the current Pegs/Ribavirin and discontinues, the VIRUS MUTATES. It will also make your viral load increase significantly. Please take this into consideration also when evaluating what course of action you are going to take.
This will have an impact on future treatments if you decide to discontinue.
EarthMan
As stated, hepatitis c is generally a very slow moving disease. I don't know how long you've had it but for me it's 37 years and I'm still a stage 2-3.
Your doctor is taking a very pessimistic view of the newer drugs in trials. 2-3 years is what a lot of us are hearing and the results, while not guaranteed, certainly are promising. Again, you have so much time to wait if you so choose that all cards are in your favor.
As to what I'll do if my hemoglobin keeps dropping, I really will have no choice but to reduce the ribavirin at some point. I don't think going beyond 60,000 U/week of Procrit will make any difference. So far the jump from 40,000 to 60,000 hasn't produced any results.
My NP said "I don't want to alarm you but Interferon can produce kidney damage"...Geee...they never mentioned that BEFORE treatment. LOL. In other words, she's suggesting that my kidney function may be somewhat compromised and that is resulting in a lower hemoglobin. But so far my Creatine is still in the green zone.
To repeat it again, there's a lot about these drugs they just don't tell you going in and a lot they don't know regarding long term effects. I still wonder what being anemic for 48 weeks will do to my brain function long-term. Because I was told my liver damage was 3/4, I really didn't have a choice. Have a good talk with your doctor and ask him what he really knows about the long-term effects of all these drugs we're taking. And keep looking in his eyes.
-- Jim
Your doctor is taking a very pessimistic view of the newer drugs in trials. 2-3 years is what a lot of us are hearing and the results, while not guaranteed, certainly are promising. Again, you have so much time to wait if you so choose that all cards are in your favor.
As to what I'll do if my hemoglobin keeps dropping, I really will have no choice but to reduce the ribavirin at some point. I don't think going beyond 60,000 U/week of Procrit will make any difference. So far the jump from 40,000 to 60,000 hasn't produced any results.
My NP said "I don't want to alarm you but Interferon can produce kidney damage"...Geee...they never mentioned that BEFORE treatment. LOL. In other words, she's suggesting that my kidney function may be somewhat compromised and that is resulting in a lower hemoglobin. But so far my Creatine is still in the green zone.
To repeat it again, there's a lot about these drugs they just don't tell you going in and a lot they don't know regarding long term effects. I still wonder what being anemic for 48 weeks will do to my brain function long-term. Because I was told my liver damage was 3/4, I really didn't have a choice. Have a good talk with your doctor and ask him what he really knows about the long-term effects of all these drugs we're taking. And keep looking in his eyes.
-- Jim
I have seen similar thoughts posted here and on other discussion groups about the virus "mutating" because of treatment, however haven't seen any studies, which doesn't of course mean they don't exist. But I would like to know what are you basing this statement on?
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