Low WBC and Neutrophils

[Dorothy and Toto]

It's me again with low numbers and wondering what to do.  My neutrophils went up two weeks ago but are back at 634.  My WBC is now at 1.4.  My ALt &Ast are both about 20.  The doc is more concerned with the neutrophils and if I don't want to go to half dose of Pegasys, he is willing to put me on Neupogen.  I suggested going one more week at 80% dose of pegasys as 3 shots a week of neupogen don't sound inviting.  Do people take both neupogen and Procrit?

I am 1A, 1 million viral load, and my biopsy came back with Grade 2, Stage 0.  From not drinking the year after being diognosed, my load dropped from over 2 million to 1.  

My doc is good at listening to my reasoning so any input you have would be appreciated!  Thanks again to everyone at this website.  It has helped me through this treatment tremendously.
Dorothy

[OkieJim]

When I was on TX I did Neupogen at .5cc twice a week. I was on TX for 24 weeks and only had to use the Neupogen for a total of 4 week. These we not concecutive weeks. The Neupogen only last for a short time as the TX distroys the Neutrophils shortly after the are produced. It does however help to keep you TX at the recomended levels without having to reduce.  My 2 cents. Hope this helps. I do know of others on this board that did both Neupogen and Procrit. The main sx's are achy bones after the injections.

[Galen]

I was on both Neupogen and Procrit from week 9 through 48.  While I had to do Procrit twice a week for about 2 months, it was once a week after that (except for a few times that my count took a nosedive). Neupogen was always only once a week.

[Indiana]

It is most important to keep your tx meds at the highest levels your body can take. If you want to clear this virus then you have to take the recommended doses of the meds. If the Neupogen works for you and brings those counts up then that is what you need to do. Whenever we sacrifice the proper doses of our tx meds in favor or blood counts we also sacrifice our "odds" of clearing to some degree.
Bottom line....Whats important to you??.......clearing the virus or avoiding another needle stick?
It's your choice.................

[Dorothy and Toto]

Thanks for the advice.  My next question is, are my numbers low enough to go on Neupogen?

[raheem]

My neutrophils have been from 430-570 for the past 5 months.  My WBC has been 1.1-1.2.  No infections.  I'm on week 44 and only have 4 more shots left. I went down to 75% interferon at shot #30 and stayed on full dosage of riba (1000mg.) throughout tx.  That will give me 91% of the interferon and 100% of the ribavirin....better than the 80-80-80 rule. My doc is not a Neupogen advocate as he claims his trusted oncology colleagues have a concern of a Neupogen/leukemia risk. However, I cannot find any studies indicating as such nor could he direct me to any data.  "Daria" posted a few days ago and said that his doc would not prescribe Neupogen after attending a conference in LA.  I'm not sure what his doctor's concern is though.  Perhaps Daria can tell us.  Procrit is great stuff.

[MajNeni]

Dorothy, your numbers are definitely low enough.

I took Procrit From week 4 on.
Weeks 33-41 I took 60K of Procrit/week- 40K Monday, 20K Thursday.
Weeks 42-48 I took 40K on Mon. and 40K on Thursday.

I took Neupogen from week 15 on.
Weeks 19-27 and weeks 31-48 I took Neupogen 2x/week.

I am now almost 10 weeks post tx.  At the 6 weeks post checkup, my RBC/HGB were coming up nicely, though still low; my WBC/ANC were low, too, (WBC 1.9) so my doc told me to take my Neupogen leftovers.  So far I've had 3 weekly shots, and have two or three more.  He figures my body should catch up by then.  Next follow-up/CBC is at 12 weeks post, coming up.

During tx, my Pegasys was reduced 2x to half shots, not by my doc, but by his associate, who was on call and got alarmed when the lab results came back in the evening, and called me STAT.  My doc was sorry about that, and told me to ignore it if Dr.C calls on Monday night and tells me that again.
My Ribavirin was reduced a whole lot because my red counts went so low.  I was on 1200 mg of riba officially; was ordered off so much in the last 6 months, that I actually missed about 350 pills.  I went on my own and took 1000 MG the last 6 weeks...
I was clear from 12 weeks to 48; so if I don't get SVR, I'll have my suspicions.  

BTW, the red counts, hemoglobin and hematocrit DON'T drop because the ribavirin causes the body (the bone marrow) to make too few red cells.  They drop because the ribavirin hemolyzes, i.e. kills off,  lots of red cells before their time.  Red cells are supposed to live about 130 days, but riba can kill them off after 70 or 80.  This is medical info, so think clean:  I actually peed brown the week before I started Procrit when I was hemolyzing so rapidly.  
Procrit stimulates the bone marrow to grow and release more red cells faster, from STEM CELLS.  Heard of those before?  Think of the jokers in Washington making decisions about stem cell research now!  Anyway, sometimes this process will create immature red cells being released into the bloodstream, and the blood count will show (under "morphology") a bunch of different types of red cells.  (Macrocytes, etc. with numbers like 1+ and 2+.)  Not to worry too much, as long as HGB and HCT are not too bad.  But those terms and numbers are interesting to throw into a dull conversation when the other topics are petty and irrelevant to anything...

Stay tuned to see if I end up glowing in the dark from all my Procrit and Neupogen.  Stopping 5 shots a week was really sweet; yes, the 48 weeks passes.  All of you taking just one needle, please chill... ok, I'll be nice again.  
Maj Neni

[DH Bill]

Nice to hear a little **** and vineger from you tonight. Less fog huh.

[Ella Mackenzie]

All my counts are super low, almost at the point to medicate but for now, my doctor said to wash my hands often and cook all my vegies and no strawberries or other fruits that are difficult to wash. Oh, and I guess no cookie doe for a while, either.

[cheriums]

I'm recommending, not as a substitute for Rx drug/ growth factor, but in addition or while waiting to see:  Coriolus mushroom.  (aka "Turkey Tail," or Trametes versicolor or Yun Zhi in pin yin).  The Japanese have done 300 studies, found this herb is powerful help in boosting or maintaining WBC during chemotherapy.  They Rx it along with the drugs.  When my WBC and ANC were dropping rapidly, I boosted my dose of Coriolus to 2 grams, twice/ day. (I started treatment taking 400 mg twice / day; not understanding how rapidly the cell counts could drop, I was only gradually increasing the dose.)  My WBC and ANC are on the rise. Not rapidly, but rising is better than continuing to drop! A reliable brand is MushroomScience.