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Blood Work,,, Advice TnHepGuy, All
Hi,,,I didn't want to start a new thread but for some reason I couldn't post a comment on existing thread??? Anyways,,,Just got back from Dr and I'm really upset. My bloodwork was all acceptable but my hubby's neutrophils dropped to .....0.6. Dr said he is to stop treatment totally today. That it is so low at this point that it is dangerous. Funny thing is,,,he has been doing so good and not having problems so this was such a shock to us both.
I asked about neuopogen and Dr said at this point he would need to stop and redo bloodwork next week. I even tried to get a prescription saying it might take awhile to get filled if pharmacy had to order so I would not be leaving that office without prescription in hand! Dr. Said We will see after next week and I'm not familiar with it and will have to do some research by weight etc... I tried to argue saying there was several people that continued with this and we could even do bloodwork in 3 days to monitor. Then he says,,,Ms,,Your husband could die if this gets lower,,,So Drop it! Anyways,,I guess I'm really upset because I'm scared if he stops totally,,,that is 6 months down the drain of hard work! What happens if you stop say for a week or 2,,,,would you all think? Ending on a positive note,,,,6 months pcr for him,,,,undectable!
I asked about neuopogen and Dr said at this point he would need to stop and redo bloodwork next week. I even tried to get a prescription saying it might take awhile to get filled if pharmacy had to order so I would not be leaving that office without prescription in hand! Dr. Said We will see after next week and I'm not familiar with it and will have to do some research by weight etc... I tried to argue saying there was several people that continued with this and we could even do bloodwork in 3 days to monitor. Then he says,,,Ms,,Your husband could die if this gets lower,,,So Drop it! Anyways,,I guess I'm really upset because I'm scared if he stops totally,,,that is 6 months down the drain of hard work! What happens if you stop say for a week or 2,,,,would you all think? Ending on a positive note,,,,6 months pcr for him,,,,undectable!
Hey,,,What can I say.... except each and everyone are so awesome! I owe everyone here a big favor! Today has been a wild day between some business have toos and trying to check out everything I can get my hands on for not stopping meds, I have now either had a phone to my ear and/or on computer. Everyone here that is experiencing tx right now or has knows....That you wouldn't want to get to 6 month svr to mess up if there is a possible answer. Who wants to start over? Not Me! TnHep...some great advice as usual,,,didn't even think of calling pharmacy etc...and just did and of course not in stock but can get within 2 days. Another great point...For All Newbies,,,,Check with your dr in beginning to see what happens or he uses if falling down in blood work. I guess we jumped to quickly and were scared and just started tx. I have learned so much about this disease and tx through you guys! I even called before 5 drs office again and said,,,we wanted at least to try the medicine to see if it would work and if a problem,,,We could find someone else to prescribe so hopefully the Good Dr. will do his catch up reading tonight (smirk)
Anyways Rev,,,yes we do have supply for next 6 months so the meds are no problem. He is going to continue full riba like you suggested and hopefully we will have an answer on neupogen before next sunday (shot nite) and if not,,,Take reduced shot!
Yeah Couch,,,I also thought same about no problem here in states getting extra meds,,,Guess I was wrong! Now I know what you all go through and its just scary to think you might be starting this wild adventure and then have no back up right smack midway.
Thanks,,,So Much!! (((((HUGS)))) To the Best People!
Anyways Rev,,,yes we do have supply for next 6 months so the meds are no problem. He is going to continue full riba like you suggested and hopefully we will have an answer on neupogen before next sunday (shot nite) and if not,,,Take reduced shot!
Yeah Couch,,,I also thought same about no problem here in states getting extra meds,,,Guess I was wrong! Now I know what you all go through and its just scary to think you might be starting this wild adventure and then have no back up right smack midway.
Thanks,,,So Much!! (((((HUGS)))) To the Best People!
<a href="http://www.clevelandclinicmeded.com/hcv/cma.htm">Hepatitis C Management Monograph - Clinical Management Algorithm</a>
(from the paper):
"<i>If side effects become intolerable or if there are marked decreases in the absolute neutrophil count (<b><500</b> cells/mm3) or platelet counts (<30,000 cells/mm3), adjust the dose of PEG-IFN downward. Again, <b>we recommend adjunctive therapy with filgrastim (i.e. - Neupogen)</b> at the physician's discretion as well as more frequent monitoring of blood parameters. <b>The clinician must keep in mind that the dose-reduction recommendations contained in package inserts are overly cautious, and most clinicians do not adhere to them.</b></i>"
<a href="http://www.hivandhepatitis.com/hep_c/news/082503a.html">Management of Hematologic Disorders Associated with Hepatitis C Virus Infection</a>
(from the paper):
"<i>The most important factors in successful eradication of HCV are adherence to therapy and dose maintenance .....
Strategies for Treating Hematologic Disorders in HCV-Infected Patients .... Granulocyte colony-stimulating factor (G-CSF): Recombinant human G-CSF (filgrastim, an agent that enhances granulopoiesis in neutropenic patients with cancer who are receiving IFN-alfa), stimulates production of multipotent hematopoietic progenitor cells and mature granulocytes.
Although there are no guidelines for the use of G-CSF in the HCV-infected population, the rationale for its use is predicated on its success in patients with cancer who are receiving chemotherapy.</i>"
<a href="http://www.ccjm.org/PDFFILES/hepadOng.pdf">Managing the hematologic side effects of antiviral therapy for chronic hepatitis C: Anemia, neutropenia, and thrombocytopenia</a>
(from the papaer):
"<i>Management looks to granulocyte colony-stimulating factor
The management of neutropenia, like that of anemia, is variable. While some clinicians tolerate more profound neutropenia before recommending dose reduction, others are using filgrastim to raise the neutrophil count in HCV-infected patients receiving combination therapy. Filgrastim is a recombinant human granulocyte colony-stimulating factor (G-CSF) that is used to increase white blood cell and neutrophil counts in cancer patients with chemotherapy-associated neutropenia. Very few studies have reported the use of filgrastim in patients with chronic hepatitis C. Van Thiel and colleagues19 evaluated filgrastim as an adjunct to interferon in HCV- infected patients with advanced liver disease. All 30 patients had histologically confirmed cirrhosis. They were randomly
assigned to receive interferon alfa-2b alone or with 300 mg of filgrastim given twice a week. The dose of interferon alfa-2b was 5 MU daily. Although the mean and peak white blood cell counts were higher for the patients receiving filgrastim, the nadir values were the same between the two treatment groups. A
higher proportion of patients receiving filgrastim (53% vs 40%) achieved SVR, but this difference was not statistically significant. Filgrastim appeared to be fairly well tolerated in this study. In a more recent study,20 the use of filgrastim allowed patients to resume and maintain their full dose of
peginterferon. In an additional study,17 filgrastim was used to manage neutropenia in 39 patients who were treated with peginterferon alfa-2b and ribavirin. Preliminary results from this study demonstrate that 89% of patients receiving filgrastim had significant improvement in their neutrophil count (Younossi, unpublished data, 2004). <b>Together, these results indicate that filgrastim may be safe and effective in raising neutrophil counts in HCV-infected patients undergoing antiviral therapy.</b> Nevertheless, future research will be important to better understand the clinical implications and management of neutropenia in these patients.</i>"
TnHepGuy
http://www.clevelandclinicmeded.com/hcv/cma.htm
http://www.hivandhepatitis.com/hep_c/news/082503a.html
http://www.ccjm.org/PDFFILES/hepadOng.pdf
(from the paper):
"<i>If side effects become intolerable or if there are marked decreases in the absolute neutrophil count (<b><500</b> cells/mm3) or platelet counts (<30,000 cells/mm3), adjust the dose of PEG-IFN downward. Again, <b>we recommend adjunctive therapy with filgrastim (i.e. - Neupogen)</b> at the physician's discretion as well as more frequent monitoring of blood parameters. <b>The clinician must keep in mind that the dose-reduction recommendations contained in package inserts are overly cautious, and most clinicians do not adhere to them.</b></i>"
<a href="http://www.hivandhepatitis.com/hep_c/news/082503a.html">Management of Hematologic Disorders Associated with Hepatitis C Virus Infection</a>
(from the paper):
"<i>The most important factors in successful eradication of HCV are adherence to therapy and dose maintenance .....
Strategies for Treating Hematologic Disorders in HCV-Infected Patients .... Granulocyte colony-stimulating factor (G-CSF): Recombinant human G-CSF (filgrastim, an agent that enhances granulopoiesis in neutropenic patients with cancer who are receiving IFN-alfa), stimulates production of multipotent hematopoietic progenitor cells and mature granulocytes.
Although there are no guidelines for the use of G-CSF in the HCV-infected population, the rationale for its use is predicated on its success in patients with cancer who are receiving chemotherapy.</i>"
<a href="http://www.ccjm.org/PDFFILES/hepadOng.pdf">Managing the hematologic side effects of antiviral therapy for chronic hepatitis C: Anemia, neutropenia, and thrombocytopenia</a>
(from the papaer):
"<i>Management looks to granulocyte colony-stimulating factor
The management of neutropenia, like that of anemia, is variable. While some clinicians tolerate more profound neutropenia before recommending dose reduction, others are using filgrastim to raise the neutrophil count in HCV-infected patients receiving combination therapy. Filgrastim is a recombinant human granulocyte colony-stimulating factor (G-CSF) that is used to increase white blood cell and neutrophil counts in cancer patients with chemotherapy-associated neutropenia. Very few studies have reported the use of filgrastim in patients with chronic hepatitis C. Van Thiel and colleagues19 evaluated filgrastim as an adjunct to interferon in HCV- infected patients with advanced liver disease. All 30 patients had histologically confirmed cirrhosis. They were randomly
assigned to receive interferon alfa-2b alone or with 300 mg of filgrastim given twice a week. The dose of interferon alfa-2b was 5 MU daily. Although the mean and peak white blood cell counts were higher for the patients receiving filgrastim, the nadir values were the same between the two treatment groups. A
higher proportion of patients receiving filgrastim (53% vs 40%) achieved SVR, but this difference was not statistically significant. Filgrastim appeared to be fairly well tolerated in this study. In a more recent study,20 the use of filgrastim allowed patients to resume and maintain their full dose of
peginterferon. In an additional study,17 filgrastim was used to manage neutropenia in 39 patients who were treated with peginterferon alfa-2b and ribavirin. Preliminary results from this study demonstrate that 89% of patients receiving filgrastim had significant improvement in their neutrophil count (Younossi, unpublished data, 2004). <b>Together, these results indicate that filgrastim may be safe and effective in raising neutrophil counts in HCV-infected patients undergoing antiviral therapy.</b> Nevertheless, future research will be important to better understand the clinical implications and management of neutropenia in these patients.</i>"
TnHepGuy
http://www.clevelandclinicmeded.com/hcv/cma.htm
http://www.hivandhepatitis.com/hep_c/news/082503a.html
http://www.ccjm.org/PDFFILES/hepadOng.pdf
So sorry that your doc is so in the ice age,,,,hope something works out,,,,,I know everybody PRAY that it will all work out ok. OKAY?
I do have some good news, I am on week 14/48 and my 12 week
viral load quantitative was 0 yes that's a big zero. I feel goood about it esp since i am genotype 1A,,,,but i am figuring
on and wanting to go on after my 48th week,,(if i can) and continue long term tx
I do have some good news, I am on week 14/48 and my 12 week
viral load quantitative was 0 yes that's a big zero. I feel goood about it esp since i am genotype 1A,,,,but i am figuring
on and wanting to go on after my 48th week,,(if i can) and continue long term tx
Well my hepatologist start neupogen under 0.5, and he is doing hep c and only hep c in a university research hospital. I've always been surprised by the level of biological test I was instructed to see him or someone of his staff at once (1000 for the ALAT, less than 20 000 for platelets, more than 500 for GGT ...) and "normal" lab results. I've been on normal interferon, normal interferon and riba, Schering peg interferon (viraferon peg) and riba, and now Roche peg interferon (pegasys) and riba. This is my fourth treatment. I definitively prefer Pegasys: sides differents and much mor manageable for me. For those of you who remember I posted some weeks ago: sudden total loss of hearing at right ear (due to compression of the auditive nerve). I declined the ten days hospitalisation to receive treatment, so I got the treatment at home (doc do not like you to take those meds outside hospital, they get you very confused (i can confirm) and in my case induced real narcolepsy). The good news is that hearing is back as before, that my PCR is still limit detectable (700 UI/ml level of the test at 615) (afer 10 days of high dose corticoid), that I'm back to full dose Pegasys (was reduced to 135 during one month). The bad news is that it seems I've a brain 20 years older than my biological age. I'm undergoing an 18 months treatment this time.
I agree with Southernboy, .6 is okay if he can get a dose of neupogen in today or tomorrow...When is he scheduled for his next Peg shot? I would fight to keep him on the current dose and just add a shot of neupogen 300mcg once or twice a week (monitor)to see his response...Neupogen works immediately and will most likely raise his white cells more than enough to continue with the current dosing..My daughter was on neupogen twice a week...She needed it from her first week of therapy on...They also almost stopped her but the neupogen worked almost instantly...
Good Luck and let me know how you make out..
Jodi
Good Luck and let me know how you make out..
Jodi
Hi there honey,
0.6 is low but I think it is not as critical as your doc says it is. My docs started me on Neupogen when I broke below 1.0. I had previously been below 0.5 (this was during my first round of tx) with no panic, dose reductions or adverse reactions. As a side note, I was told that Neupogen is very fast acting (as is not the case with Procrit which can take several weeks to kick in). It's effects start happening within a day or so. I do not think stopping tx is the ideal thing to do. I would insist on Neupogen immediately. This is his life we are talking about and it sounds like your doc is just following the approved protocol, which we know does not always work with tx.
Best to you and hubby,
Steve
0.6 is low but I think it is not as critical as your doc says it is. My docs started me on Neupogen when I broke below 1.0. I had previously been below 0.5 (this was during my first round of tx) with no panic, dose reductions or adverse reactions. As a side note, I was told that Neupogen is very fast acting (as is not the case with Procrit which can take several weeks to kick in). It's effects start happening within a day or so. I do not think stopping tx is the ideal thing to do. I would insist on Neupogen immediately. This is his life we are talking about and it sounds like your doc is just following the approved protocol, which we know does not always work with tx.
Best to you and hubby,
Steve
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