Low white blood cells with tx

I began Pegasys/Ribaviron therapy this past January. From the beginning, my white blood cell (WBC) count started falling with a corresponding drop in ANC. The doctor ended up reducing the Pegasys. He had me skip doses entirely when the reduced dosage didn't have an adequate effect. Then, on 4/22 I started Neupogen, combining 300 mcg with a full dose of Pegasys. WBC dropped to 3.25 so on 4/29 I did 300mcg Neupogen and 1/2 dose Pegasys. On 5/6 WBC was at 2.66 and he had me skip Pegasys and do 450mcg Neupogen. On 5/13 WBC was 2.48 so he stopped everything but the Ribaviron. I see him next week to find out what next.! Have you heard of this kind of reaction?? I really want to continue therapy but I'm afraid I might not be able to.Though I don't have the exact numbers with me, I don't believe the ANC has ever dropped below 900.

[Southernboy]

Hi,

Many experienced docs don't start getting concerned until the ANC gets below 500.  Neupogen works almost immediately.  If your dose is not high enough then it should be increased.  I have been on doses as high as 300mcg every 3 days.  This helped me.

Best to you and I hope this helps,
Steve

[honey1616]

Sorry to hear that your dr is reducing and stopping meds?  How many people is he or has he treated with hep c.  Honestly,,,those numbers look great for being on tx....That is just flat out normal to be falling to those levels.  Mine even fell to 1.8 during tx,,,,and was just being monitored.  If it was in the 2's,,,I was thrilled and 3's are just great lol.
The problem is some drs just don't treat aggressively enough because this virus is so hard to beat to begin with and reducing and stopping meds,,,certaintly don't help matters.  I had to change drs halfway through midstream just to stay on meds and then found one that was more up on treatment.

[snook_man]

My WBC's droped to 3 within the first 2 weeks. I'm on week 30 right now, and as of last labs, WBC's where down to 1.6. My nuetrophils down to 632.. Dr told me they would monitor, but at this time the drops are 100% normal and no reductions in doseing would be given. Sounds to me like you found yourself a DR that is new to this is only had the HCV power point presentation...

[bunkywoo]

Sorry to hear your having trouble with your WBC. Been there done that. In reading your post, I am noticing that your doc had you do your first shot of Neupogen the same day as your Pegasys. Then you said he had you do Neupogen, no Pegasys and then one week later your WBC was still low. One thing about Neupogen is that it kicks your WBC up immediately, but can fall almost as fast. My doc had me do the Neupogen shot on Thursday night and my Peg-Intron on Friday. It seemed to work for me using that method. Also, you stated that your doc had you "combining" pegasys and Neupogen - were you mixing them together in the same syringe or were you just doing each shot simultaneously? You may want to try the one shot one day other shot next day method and see if that holds your WBC up for a little longer.

Good luck to you.

Laurie

[Lynne5477]

I did 48 wks tx and my WBC hung around 2.2 almost the entire time.  I dropped to 1.6 and 1.8 on two occassions.  My ANC stayed around 1.1 most of the time.  My dosage was never reduced and I was fine.

My doc did try to reduce my dosage once when my Hbg dropped to 9.1 but I did another blood draw immediately and it was back at 10.0.  She wasn't too happy with me over that but guess she got over it.

Good luck to you.

[caekus]

Thank you all for responding. I've read enough to know that reducing the meds drastically decreases the chance of achieving SVR. How do I find a doctor who might not look at these results quite so conservatively?

[LvdByGod!]

the advice above is great. time for a new dr or to teach your dr. but, no more med drops...

to find a good dr you just got to figure out who has the most experience with the hep c treatment...some people go to the teaching hospitals or major hospitals and find a hepatologist...a good hepatologist will know what's up for treating sides...

and you should not hesitate to interview your choices to find out if they have a record of using nuepagin or procrit and other side effect meds in order to keep the patients on full doses...you're looking for someone who treats aggressively and who is up on the latest ways to help someone through treatment...there are good gastros too but they will usally not have as many heppers in treatment as a hepatologist...

i hope you can get back on full treatment as soon as possible so you can kill those suckers!