Need advice,should I say yes to neupogen?

[nency]

Hello everybody, I hope your Tx going with less sides everyday. Today I have a question about my WBC, they 2.3 now and ANC 1200, so my hematologist wants me to be on neupogen, but my GI said it is O.K., just repeat my cbc in one week. Now, I do not know what to do! My GI does not know that I had consultation from hematologist, I was just panicking and got some other opinions, that made me to be confused even more.
I would be happy to hear your advices.
Best regards to all of you.
Nency

[jmjm530]

Absolute Neuts = ANC. Your ANC therfore is 1520 or 1.52, depending on the scale. That's very good from what many of us have.

[katerika]

My bloodwork has measurment for Neutrophils absolute with a ref. range [1.90 -7.80]
I don't see an ANC reading, is this found on a regular CBC?
My reading is 1.52
WBC  2.4
Heme 9.8
I am now on Procrit, once a week,
Thanks

[jmjm530]

Frijole: The problem with most hemotologists is that most don't have  experience with hepatitis C treaters.  
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Bingo! Yes, that's the distinct feeling I get as well. But what I ask myself -- and it's just not with hemotologists -- is why if a patient walks in a doctor's office with Hep C, doesn't the doctor take the time to up-date him/herself on all that is relevant in their speciality? When I get a new client, I take that time to find as much about their business as possible. Anyway...too early in the week to get going on this :)

Frijole:   The problem I have with the study Jim posted is that you can't tell the amount of neutopenia the subjects had.  That is the problem with abstracts.
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Yes, I agree again. No doubt that is the reason why all medical teams aparently intervene at *some* point. And I agree about abstracts versus full-text. Full-text is usually available on-line for a fee -- and I paid for full-text for every study that affected my treatment and the ones I brought to my doctor for review, not that I deceive myself into believing my doc actually read the full-text :)

Frijole: I think that Neupogen is a good idea if the ANC drops below 500.  You are far from that.  Another thing that has bearing is your susceptability to colds and infections.
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Disagree a bit here but so do the various docs :) Maybe if ANC *held* at 500 or below for several weeks, but ANC does have a habit of bouncing back, as my did from around 300 to over 1000 in just two weeks. As to "colds" it seems that the interferon protects many of us during tx from that. I never got a cold during tx but that may have been because I rarely left the house :)

-- Jim

[frijole]

The problem with most hemotologists is that most don't have  experience with hepatitis C treaters.   Most of their experience is with cancer patients on chemotherapy and cancer patients can get a heck of a lot of weird infections on chemo when the neutrophils drop below 1500.  So they try to treat us with that criteria.  The problem I have with the study Jim posted is that you can't tell the amount of neutopenia the subjects had.  That is the problem with abstracts.  It could be that just those that got infections had very low ANC.

The range that hepatologists will let ANC get before recommending Neupogen is great.  I personally started Neupogen when the ANC hoovered at 400 for a couple of weeks.  I fought off my hemotologist before that.  However, i think it is excellent that you have one (hemotologist).  Blood is their specialty and they are much better at monitoring than other doctors.  

I think that Neupogen is a good idea if the ANC drops below 500.  You are far from that.  Another thing that has bearing is your susceptability to colds and infections.  We are approaching the flu seaon and lots of germs floating around.  Better to be safe with Neupogen than sick.
frijole

[jmjm530]

Different medical teams have different ANC intervention points where they either intervene with Neupogen and/or reduce the Peg dose. According to accounts here, that point has ranged from ANC 1200 to ANC 200-300. Most common here seems to be ANC 500-750. I don't know exactly why each team has their own point, you'd have to ask them. My NP says they rarely intervene with Neupogen because "it isn't necessary" :) but in fact, she did tell me it would probably go back up when it was around 300 and indeed in a couple of weeks it was over 1000.

-- Jim

-- Jim

[wyntre9]

Thanks you too.

merry,

You're not the first person to mention that and I keep forgetting to ask my Dr!

I checked 9/14 labs and they're still around 2 and have been at that point or lower for 12 months.  When I did ask, last March, Dr. did say he thinks the neupogen keeps my WBC/ANC from going any lower.

Thoughts on that?

Jmjm,

SO, if that article is true, why doya think Dr. put me on neupogen in the first place?


wyn

[jmjm530]

Wyn,

Those numbers appear to pertain to the relationship between low ANC in those not treating. According to this study, and my doc, it's a different story while treating and that's why many doc's will not intervene until ANC is below 500 or even lower.

http://tinyurl.com/2g2epe

The relationship between infectious complications and neutropenia was evaluated in recipients of interferon-based therapy for hepatitis C followed at The Ottawa Hospital Viral Hepatitis Clinic from June 2000 to May 2005. One hundred ninety-two patients received 211 courses of therapy (5707 person-weeks of therapy). No patients received granulocyte colony-stimulating factor. Sixty-seven infectious complications occurred in 57 patients (1.17 infections per 100 person-weeks of therapy). The median time to infection was 17 weeks after the start of therapy. Age, sex, weight, race, human immunodeficiency virus status, stage and grade of biopsy, and type of interferon were not correlated with infection rate by Cox regression analysis. The rates of total, fungal, viral, and bacterial infections did not correlate with nadir neutrophil count or magnitude of decrease from baseline. Neutrophil count is not correlated with infection rate in recipients of interferon-based therapy for hepatitis C. Reduction in interferon dose and/or dosing with granulocyte colony-stimulating factor in those with neutropenia is not supported by this analysis.

[merryBe]

this begs the question, could maybe the neupogen not be the best choice for you, given your current zero energy level?? I'm not sure why, but my guess is, the insurances prefer the cheapest drug,
but the criteria for switching to a more expensive and often better molecule for treatment precisely IS if the patient has a containdicstion/tolerance/non-responsiveness issue. so this may be another idea for you.

[alagirl]

my wbc is down as low as yours and my anc is LOWER than yours and I my hematologist is not having me do neupogen or neulasta at this time and neither is my tx doctor.  Just to let you know.  I am on 40,000 units per week of procrit for my low red blood cell counts.

[wyntre9]

here's a link with inf about WBC and ANC,

file:///C:/Documents%20and%20Settings/Owner/Desktop/low_blood_counts.asp2.htm

wyn

[wyntre9]

ANC is Absolute neutrophil count.  It usually has more weight than the WBC alone.

I'll try to find the link with the info and post it for you.

wyntre

[sfwandwow]

hey i take neupogen once a week.. every tues evening.. It just makes me ache somewhat. iam confused what is anc?

[wyntre9]

I am on neupogen for low WBC and ANC but I have to admit it's confusing to know when levels are too low as apparently many doctors have very different opinions on the matter.

here's something i googled earlier whan i was wondering the same thing.

wyntre

Normal Adult Values
White Blood Cell Total 4-11 k/ul
     Lymphocytes 22-44%
     Monocytes 0-7%
     Granulocytes
          Neutrophils 40-70%
          Eosinophils 0-4%
          Basophils 0-1%
Note:  Normal values will vary from laboratory to laboratory.


When you have a low white blood cell count there is an increased risk of infection.  The level of risk depends on several factors:

    * How low your white blood count falls
    * How long your white blood count is low
    * Which type of low white blood cell count you have
    * Other medications you may be taking such as steroids or immunosuppressive agents (cyclosporin).

One measure of risk is the absolute neutrophil count (ANC).  The ANC is calculated by multiplying the total white blood count by the percent of neutrophils (also called segmented neutrophils, segs, polymorphoneucleated cells or PMNs, polys)

Total white blood count  x % neutrophils* = ANC

* Neutrophils may be reported as segs & bands (a band is slightly less mature form of a seg).  In this case add the % of segs to the % of bands then multiply by the total number of white blood cells.

(% segs + % bands) x Total white blood count = ANC

Risk of Infection based on Absolute Neutrophil Count (ANC)
ANC greater than 1500 No increased risk of infection
ANC 1000-1500 Slight increase in risk of infection
ANC 500-1000 Moderate increase in risk of infection
ANC 100-500 High risk of infection
ANC less than 100 Extremely high risk of infection


l

[FL_Gal]

From what I understand, those numbers can bounce around pretty much on their own.  If I hadn't been getting massive infections every time I got so much as a paper cut, I wouldn't have wanted to take the Neupogen.  It made me even more crabby than I already was.

So, my opinion is listen to the GI and see how it goes.

FlGal

[jmjm530]

You should run all medications you take on treatment by your treatment doctor, and that includes Neupogen. From what I've been told, and read, I happen to agree with your treatment doctor. You sound like you may not have confidence in your treatment doctor. If this is the case, I'd look around for a treatment doctor you do have confidence in.

-- Jim