Extended TX and Nuepogen

[donnieraye]

My GI will not extend my Tx because I cannot be off of Nuepogen.  I have been on 3 shots a week since wk 3.  I dont believe I can get a Hepatologist on SSI and Medicade.  I became UND betweeen wk 12 -24.  I'm 1a wk 40 of 48.  Any advise please.  


Donnie

[Rockerforlife]

Patients on PEG(40kDa) IFN -2a who did not achieve an undetectable virus or a viral decline of 2 log from baseline had only a 2% probability of achieving a sustained virological response (ie, 0.98 negative predictive value)." Based on an intent-to-treat analysis among 564 patients who received PEG(40kDa) IFN -2a, the positive predictive value for achieving a sustained virological response for either an undetectable HCV RNA level (<100 copies/mL) or a 2-log drop in viral load from baseline was 0.45. However, the negative predictive value of this parameter was much higher. Patients on PEG(40kDa) IFN -2a who did not achieve an undetectable virus or a viral decline of 2 log from baseline had only a 2% probability of achieving a sustained virological response (ie, 0.98 negative predictive value).

http://www.hepcassoc.org/news/article15.html

[Rockerforlife]

From what im hearing from ny nurse...things are changing,,they now allow to continue with tx,even tho blood counts are lower than normal...getting more agressive i guess...now im only talkn WBC here...i now she did mention that to me

[frijole]

Yes you probably do need the Neupogen with ANC hovering at 500.  Start working on your GI.  Most GIs say the insurance companies won't pay but usually it is just that their book says SOC is 48 weeks and you did get your 2 log drop at 12 weeks so they are happy.  MOst of the time the insurance companies will pay if the GI rx'es it and I think medicaid would pay too.
frijole

[frijole]

ANC is your absolute neutrophils.  Shown on your labs as ANC or #NE  I think.  It is the count of the neutrophils in your white blood count.  Here is an ANC calculator.  If your labs don't show bands, don't put anything in (I think those are baby neutrophils)

http://www.curehodgkins.com/hodgkins_resources/anc_calculator.html

I think you are a great candidate to extend given your 12 week count. I would push for extension and give your doctor some studies on extension - like the Berg and Tapias Sanchez.  If you can't find them online PM me and I will locate them for you.  I treated with a GI who (in 2005-2006) would not let me extend.  I finally convinced him to extend to 56 weeks but not any longer. (I had 40 VL at week 12 and relapsed). Now (2008) he is savy to 72 week treatment so I think the word is getting filtered down to GIs at long last.  If you can't get the Neupogen due to the Medicaid and you do need it, you might be able to get it from the drug company. . I will look  - seems like I have an address somewhere.
frijole

[donnieraye]

Thank you, yes my Absolute Neutrofils have been low since Tx began.  We have been struggling to keep them above 500.  

[Rockerforlife]

Neutrophils

W.B.C. (White Blood Cell Count)
White blood cells main function is to fight infection, defend the body by phagocytosis against invasion by foreign organisms, and to produce, or at least transport and distribute, antibodies in the immune response. There are a number of types of leukocytes (see differential) that are classified as follows

Granulocytes
Nongranulocytes

Band Neutrophiles
Lymphocytes

Neutrophils
Monocytes

Eosinophils
  

Basophils
  


Each cell, or leukocyte, has a different job in the body which is explained in the Differential section.

Normal Adult Range: 3.8 - 10.8 thous/mcl
Optimal Adult Reading: 7.3
Higher ranges are found in children, newborns and infants.

[Rockerforlife]

same as saying..."white blood cells"

[Rockerforlife]

Your ANC is too low...thats your problem..its your "absloute nuturfill count'(spelling)

[donnieraye]

Thanks for your response.  My BX results are 2/3,  My begining VL was 2.250000, and my VL at 12 weeks was 1100.  I am unsure of my ANC.  What is it?

Donnie

[frijole]

I looked in your profile but didn't see what your liver damage is.  What was your beginning VL and when did you clear. What was your VL at 12 weeks -- it is those with VL under 6000 that may benefit from extended treatment.   What has your ANC been during tx.  The fact that you are taking Neupogen 3x a week leads me to belive you are cirrhotic or close to it.  
frijole