Low neutrophils week 1 - geno 3 relapser

"Comeagain", my ex, just started retreating in a study for geno 3 and 2 relapsers. 48 weeks of 180 mcg Pegasys and 1200 mg Copegus. Last tx was 24 weeks, not weight based, with only 100 mcg PegIntron and 800 mg Rebetol. He weighs 200 lbs, and is 5 ft 9 inches tall.

Today he received a call from his nurse that his neutrophil count has fallen to 0.6 after only 1 week of tx. He is to reduce his shot tomorrow to 135 mcg Pegasys. They don't like the quick fall of neutrophils after just one shot. They say if his neutrophil count goes up he might be able to return to full dose later on.

Last tx his neutrophils went from baseline 2.1 to hover between 0.9 and 1.0. In his 5th month of tx they fell to 0.7, then up to 1.0 again, then down to 0.7.

I do not like this reducing of interferon so early on in treatment.  All other blood counts are okay, so the decision to lower the interferon is just based on his neutrophil count.

Is there only one choice here - to follow doctor's order? Please tell us if you know anything about how to handle this situation!

Zazza

[nygirl7]

Did you ask them why they won't try Neupogen before a dose reduction? I'd be concerned about that myself - I know that the white counts can go up and down and recover on there own...but it does sound like a pattern with him.  

I'm no expert on this stuff - my problem was with my red blood cells but what I wanted to say - you ALWAYS have the right to question the doctor on things...you hired THEM not vice versa. They work for YOU, remember that! And if they don't give you good reasoning for rwhy they are doing something you can always fire them and find somebody else.

We get so used to acting like Doctors are God because we've been conditioned (by them?) to do so but I did learn big time in treating that they certainly are not. I was fortunate. When I researched things my doc hadn't yet learned...he was willing to read them and then do what I requested (if it was sensible).  A lot of docs aren't like that.  I truly think him being willing to work WITH me instead of just telling me things is what lead to SVR.  

That's all I wanted to say. I would not want to dose reduce this early under any circumstances unless it was absolutely necessary either so...I think you should just ask them. You have nothing to lose right?

[Tallahassee]

I agree with NY.

But I'm afraid that if he is in clinical trial, they will not allow Neupogen addition.

BTW, my Nuetrophills fell fast during my last tx... faster than ever... may be ... than more you tx, then more weak bone marrow become.. ?

How are you doing?

Your end of tx should be soon!
All the best, always

[FlGuy]

How about a quick do-over of a cbc?  Since neuts do bounce around might get a different result.  Also, maybe the timing of that initial cbc had an impact.  I'd imagine that a cbc as far away from Peg day may have some influence on the neut result.  And yes, think that a dose reduction is something that a relapser does not want to do and his first tx sounds eerily familiar.

[FloridaMouse]

I took a major neutrophil dump after my first shot on my last round of treatment.  I had to take a slight reduction for my second shot as well.  I rebounded to 1000 (1.0) after the second shot and was right back up to full dose for shot 3.  Hopefully this will be your husbands case as well.

Mouse

[zazza]

Good food for thought as always. Thank you, guys. So good to have you supporting us.

Additional input is welcome as well.

Zazza

[jmjm530]

Reducing Peg at this point, esp given your ex's weight is not going to help his chances of SVR.

First, Abs Neuts tend to bounce up and down (like with your ex's last tx) and ANC 600 is not cause for alarm according to my doc. My ANC dropped to 320 at one point, and two weeks later was over 1000. No reduction in Peg. No Neupogen. That said, some docs intervene earlier with Neupogen -- let's say around ANC "500". Your "ex" isn't there yet.

You might therefore suggest to your docs that they rx some Neupogen now and have it on hand, and wait to see if ANC keeps dropping next week (he needs weekly tests) or stabalizes or hopefully rises. If it doesn't drop, then keep going without the Neupogen. If it drops below 500, then you have the Neupogen on hand. Here's a study that suggests that interferon-induced low ANC (neupopenia) is not associated with a higher infection rate during treatment.

Lastly, make sure he gets a sensitive week 4 test to see how everything is working out.

All the best,

-- Jim
http://www.hcvadvocate.org/hepatitis/hepC/Neutropenia.html

The other thing is, given his weight,  iyour ex probably could use 1400 mg/day of riba if he can tolerate, given he has already relapsed. And given that he's 5'9" -- unless he is a weight lifter, he seems to be carrying around a lot of fat (high bmi) which also can make SVR more difficult and another reason maybe to up the drugs.

[wyntre9]

My neuts and WBC tanked within the first 3 weeks.  My Gastro sent me to a hemo and told me not to do shot # 3 or 4 (can't remember) until I'd seen him.  Hemo gave me neupogen and said it was ok to do pegasys that night.

Have been on 2x monthly neup ever since and levels have stayed around 2.0.

i agree with NYGirl:  Why can't your ex's Dr. have him do a couple of neup injections before reducing his peg?

hugs,

wyn