Temp. Stopping Tx..a set back?

I'm at week 12 of 24. Have type 2. On Riba 1200 p/d weekly injection interferon 180. I also have been needing Nupagen on a weekly basis due to low white count. My doctor tried to lower the interferon from 180 to 135 to see if my white count could be raised and stay up. Had my CBC today and my white count is now lower (I think he said .2 or .02)He said to do the Nupagen tonight(Wed.) and stop my tx until I have my CBC next Wed.
Just looking for an opinion on this. I'm not to comfortable with stopping the meds. Could this set me back? I'm also due for my 3month blood test to see if the HCV is still detectable. Thanks all.

[NYgirl]

I would not want to stop at all either. No way...I wouldn't even wanto lower meds at all. There must be SOME way else to work it out!

[jmjm530]

Did you do a 4-week viral load test?

If you haven't -- or if the test was positive -- then you really need 24 consecutive weeks of treatment at as close to full-dose as possible in order to give yourself the best chance of SVR.

Do you know what your ANC (absolute neutrophils) is? That's a lot more important than your WBC (white blood count). If your ANC is over 300, you're probably OK.

Try and discuss all this with your doc or NP today so you don't miss your next shot. If you're uncomfortable with his decision, try and make an appointment with another liver specialist ASAP, as you don't want the 12 weeks you've invested to go to waste.

-- Jim

[FlGuy]

You co0lud be at the edge of success and stopping, or reducing, could impair your chances.  You said that you are on Neup weekly, have you seen wbc's (specifically anc's as Jim mentions) rebound in your prior CBC's? Tread carfully, you don't want to risk your 12 week investment.  For many people here, Neup is the reply to the situation even though the ANC rebound from the Neup is only temporary until you need it again.

[GoofyDad]

Unless cirrhosis is present, my doc lets ANC go down to around 300. With cirrhosis, the threshold is 500-750. I was on Neup twice a week for months. It would boost my WBC within about 24 hours, but the boost would only last a few days. To keep in acceptable range I needed a shot every 3-4 days, or twice weekly. I think I read that Neup can be given daily, so I would ask for more shots before considering a dose reduction. Without my 2x/wk Neup, I wouldn't have been able to stay on full dose. Please speak to your doc about this.

[RichCM]

Sorry I do not know all the tech. stuff. But they are going by the absolute method and they are worried about it being low and at risk for infections.
To answer jmjm no I have not had a viral load test at wk. 4 I'm due for the 12 wk. next Wed. After reading your comments I have a call in to my doctor to discuss. Will let you know whats happening. Thanks again.

[mikesimon]

From Medscape 2006 see http://www.medscape.com/viewarticle/535731 - I was wrong about ANC of 500 as point of reducing or discontinuing. Sorry about the misinformation

Neutropenia occurs in 29% of HIV/HCV-coinfected patients undergoing HCV therapy.[2] PEG-IFN dose reductions are recommended if neutrophil counts fall below 750 cells/mcL and discontinuation at < 500 cells/mcL. These numbers are derived from older studies on the hazards of neutropenia caused by chemotherapy for leukemia.[6] However, in interferon-induced chemotherapy, there is a complete disconnect between neutrophil counts and occurrence of infections.[7] Neutrophil counts as low as 500 cells/mcL are well-tolerated and generally do not require an interferon dose reduction. Granulocyte-colony stimulating factor (filgrastim, G-CSF) has been used to correct this neutropenia, and there are anecdotal reports of its effect. However, this drug is not FDA-approved for this indication, and no large-scale studies have examined its safety and efficacy in the setting of HCV therapy. Black individuals have lower neutrophil counts than whites without having a higher susceptibility to infections (benign ethnic neutropenia).

[mikesimon]

If you are talking about your WBC being .2 or .02 that is really low. Neutrophils are a better indication when determining whether or not to discontinue. The rule used to be equal or higher that 750 but some doctors will let ANC get to 500 before lowering interferon or discontinuing. I think your doctor must have meant your WBC is 2 as the range is generally around 3.8-10.8 (Quest Diagnostic). I'd want to know my absolute neutrophil count (ANC) before deciding what to do. Good luck. Mike

[MissMiss]

When I was first put on Neup I was doing three days in a row.  At 40/48 I am now doing only one a week with good results.

If you are that low, why not do a Neulasta shot?  Works very quick and may just get you over this hump.  I was rushed in for one before being on Neup and my wbc skyrocketed for a couple weeks.  Talk to doc about Neulasta.

miss