Is this normal, what is next step ?

My mom started the combo treatment and is also taking the retuxin to up her platelets however they are not coming back up..after 1 low dose of combo treatment .03(i think) her platelets are now 51 her wbc is 23 she has genotype 1a . She had another combo today at an even lower dose 1/2 of normal starting dose.Next week they may start her on another shot to increase her wbc. Does this happen often?

[Bill1954]

Hi there,

I’m personally unfamiliar with retuxin. Do you know what stage of liver disease your mom is? Patients with later stages of disease are prone to low platelets and of course, the interferon can reduce platelet levels also as well.

Up until very recently, not much could be done to increase platelets in these patients, other than dose reduction of the interferon. There is a new drug recently approved by the U.S. FDA to enhance platelet production; it’s generically called ‘eltrombopag’. I understand it’s been labeled for use in ITP patients, but not specifically for HCV. We do have two HCV patients in here that use it for this purpose, however; one is in clinical trial, and the other is using it off label. You might discuss this with her doctor and see if it’s appropriate for her.

Best to you both—

Bill

[tashka]

Is your mom under care of experienced hepatologist? Rituxan is used for ITP (immune thrombocytopenic purpura), when the person's own immune system attacks and kills platelets for unknown reason. Interferon suppresses bone marrow and makes platelets low. These are two different mechanisms. I never heard of rituxan being used during hepatitis C treatment to raise platelets. Interferon stimulates immune system to destroy the virus, and Rituxan suppresses it.

Rituxan is the drug with its own list of serious side effects. Please, discuss it with your mother's doctor. If it doesn't raise her platelets, it should be discontinued.