Neupogen experience?

[jmjm530]

Until last week, my Neutrophils, Absolute has been around 1500. Last week, my 16th week of treatment, it dropped to 815. My doc said he doesn't intervene until it gets to 500, but I'd like to get prepared for the possibility.

Wondering how long does Neupogen take to kick in and are there any side effects? Also, do I need to take any precautions to avoid infection with a low Neutrophils, Absolute until the Neupogen works?

[cuteus]

I think you will be ok. mine hovered around the same number(1500to 1800) for months, dipped to 850 on the 15th mo and went back up the next month. I thought for sure it was on its way down for good.

[cigaso]

I was told my wbc started out at 4.4 and is down to 1.4. My GE is sending me to a Hematologist for Neupogen. I don't understand your numbers and my numbers. Can anyone explain? Thanks.

[jmjm530]

I was kinda hoping that might be the case but the dramatic drop got me worried.

The week my Neutrophils dropped  my WBC was 1.7. When I re-tested a week later (last week), my WBC was 2.1 but the lab screwed up the test and they could't do the Neutrophils. I'm hoping a rise in WBC correlates with a rise in Neutrophils. We'll see this week but your experience is reassuring.

[jmjm530]

Most current heptologists are concerned less with your WBC and more with your Neutrophils, Absolute. The Neutrophils, Absolute is part of a complete blood count with differentials. If you don't know that number ask your doc. If he hasn't done the test, ask him to do it before going on Neupogen.

My doc doesn't prescribe Procrit until the Neutrophils, Absolute drops below 500. I understand some may prescribe earlier, maybe around 750. Above that, it really isn't necessary, so why put it into your system. Good luck!

[TnHepGuy_]

I was on Neupogen for approximately half of my 48 week tx. It worked fast and dependably in raising my ANC (absolute neutrophil count) and WBC. The effect is fleeting though. (there is a pegylated form - which doesn't seemed to be rx'ed to tx'ing Hep C patients very often for some reason I don't know of). Some folks are ok with an occasional shot, some with weekly. There are those who need twice or thrice weekly shots to maintain acceptable ANC/WBC levels. Mine settled out to one shot per week. The major sx's I had were bone pain (mainly in my hips and thighs) and extreme fatigue on post-shot day. Teasing out the overall Neupogen fatigue effect is tough, though, given that later on in my tx the anemia was constantly flattening me, with the weekly Neupogen shot just adding to the misery.

Talk to the doc about having them monitor your serum response to the Neupogen to keep you on the minimum number of shots needed for an acceptable ANC/WBC level. In my case there reached a point where I was told to do two shots a week, and knew that it was overkill. So I asked to be cut back to one, and that worked out fine until the end of my tx.

As far as being cautious with the low ANC levels (neutropenia), the generally accepted belief is that there is no great need to be worried about your immune system being overwhelmed by some outside invader (see - <a href="http://www.hcvadvocate.org/hepatitis/About_Hepatitis_pdf/1.1_Hepatits_C/Neutropenia.pdf">Neutropenia during combination therapy of interferon alfa and ribavirin for chronic
hepatitis C</a>.(from the paper: "<i>In conclusion, neutropenia is frequent during treatment of hepatitis C with interferon and ribavirin, but it is not commonly associated with infections.</i>") and <a href="http://www.hivandhepatitis.com/2003icr/DDW2003/docs/052803g.html">Neutropenia Associated with HCV Therapy May Not Be Associated with Serious Adverse Events</a> (from the paper: "<i>(2) Infectious [serious adverse events] generally did not occur at the time of nadir ANC.</i>") and <a href="http://www.natap.org/2003/hepUpdate/day5.htm">
Threshold for neutropenia in the adjustment of interferon treatment in HCV infection</a> (from the paper: "<i>Based on these preliminary data, it can be concluded that the onset of neutropenia during combination therapy with interferon and ribavirin is not associated with subsequent infection, even in patients with post-hepatitis C cirrhosis.</i>")). Rather, the more common concerns are of longer and slower healing times and of lessening resistance leaving one open to lingering low-level maladies that may not fully resolve until the interferon is ended and the ANC rebounds.


Here's some further reading on managing sx's during tx: <a href="http://www.ccjm.org/PDFFILES/hepadOng.pdf">Managing the hematologic side effects of antiviral therapy for chronic hepatitis C: Anemia, neutropenia, and thrombocytopenia</a>.


TnHepGuy

[jmjm530]

"Talk to the doc about having them monitor your serum response to the Neupogen to keep you on the minimum number of shots needed for an acceptable ANC/WBC level."
---------------------------------------

Thanks for the advice and links.

Re "monitoring" are you talking about WBC and Neutrophils Absolute, or some other blood tests? Also, how often did you have your blood tested when you started the Neupogen?

Right now I have major bloodwork done monthly, but I'd imagine I should have at least my CBC done weekly once I started Neupogen, at least until I stabilized.

[TnHepGuy_]

I'm sure that if they start you on Neupogen they'll have you do a follow-up CBC within a week (or less) to find out what your ANC and WBC responses have been. From that point on, they should monitor you weekly until things stablize and they are happy with the 'balance' of the frequency of Neupogen shots to the serum numbers they receive. After that they can tell how your body responds and eventually have you go back to your monthly testing regime.

My first shot occured early on - at week 5 - and they monitored my CBC weekly thereafter for the next few weeks (eventually switching to every two weeks). This first shot was a temporary 'boost' (of sorts), as my overall ANC trend numbers were going down, but hadn't yet consistantly hit rock-bottom. Between weeks #5 and weeks #22 I did only a couple more shots, but it became inevitable that at some point I would be on it for good. (It was also inevitable given that the reason I was taken off of mono interferon tx way back in 1993 was due to low ANC and WBC). Starting at week #30 (having been on Neupogen full-time by then) they switched me to doing bloodwork every 4 weeks (with a six week gap actually taking place on my last one (from week 42 till week 48).

As far as my experience with the sx's go, I didn't have any for the first couple of shots. But by the third one or so, I came to realize that with every shot I would feel the bone pain and fatigue the following day. Others who have been on it have no sx's or less severe ones - very individual.

But more than anything else, I was very grateful to know that it (Neupogen) was available for me to be on to maintain full-dosage interferon - and to make it the full 48 weeks. I believe the biggest crisis I experienced was at the week #5 point, when my GIPA wanted to lower my dosage rather than allow me to wait a few more days (over the weekend) to get Neupogen delivered. It was a crazy, wild, stressful and hectic few hours - but I was able to find a vial (actually 10) and avoided any dose reduction or skips.


TnHepGuy

[cigaso]

jmjm530,
I see the difference between wbc and nuetrophils. Thanks for responding.

TnHepGuy_,
Well again thanks for the sites. I also found your information helpful to my experience. I'll be on shot 15 this weekend and most likely will start on neupogin after I see a Hematologist.

I have heard that mono therapy (interferon) was a real bear. Is this the same tx that was/is given to cancer patients?

[cbee]

A week and a half ago my absolute neutrophils were at 374.  My dr. made me do a shot of neupogen.  We did bloodwork a week later and they are at 1052. Dr. says to do bloodwork in 2 weeks but doesn't think I'll need it again.  My dr. says that I did that bloodwork too soon after my shot (shot Friday, bloodwork on Monday) which was too soon.  Who knows what to believe. Another dr. disagreed.  

As far as the shot.  I had some bone pain and can't tell if I had more fatigue than usual.  I pretty much feel incapacitated anyway.

Good luck to you,

-cbee

[dutch_boy]

I don't have too much to add as the above info is very good.  I did want to share with you that my levels dropped dramatically ..a bit lower than yours.. and the doctor prepared me that he would be sending me to a hemotologist to administer the neupogen....and the next weeks blood work (I was getting them every 2 weeks then) came back with raised levels of ANC (absolute neutrophils) and I was told I may NOT have to start neupogen.  Since then my levels have stabalized starting about week 16-18 of tx and I'm out of the danger zone.  The doctor thinks I will fluxuate a bit but never as low as it went again. So it seems like you are in a "wait and see" situation....but yours may level off on their own just like mine did. I was given the advice to be very aware of washing hands, not to be around sick folks, etc when the counts got really low.  
Hope you are doing well otherwise.
Scott

[jmjm530]

Got this week's labs back and Neutrophils up from 815 to 1152. So I guess no Neupogen for now. Frankly, another shot/drug is not what I was looking forward to. Thanks for all the advice.