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Week 20 - SOC - Low Platelets & WBC-Leucocytes - question
Week 20, Platelets = 80, WBC-Leucocytes = 2.6
Doc said that if blood test results continue to decline might be that I will have to reduce the Pegasys.
Could anyone point onto good stuff to read about that ?
How dose reductions affect SVR probability ?
Thank you,
Jack
Doc said that if blood test results continue to decline might be that I will have to reduce the Pegasys.
Could anyone point onto good stuff to read about that ?
How dose reductions affect SVR probability ?
Thank you,
Jack
Jack,
Good to see you have responded to treatment. You've been undetectable for a while now, so reducing your dosage of peg stepwise should not be an issue. If possible it would be helpful to have a viral load test done after the reduction to make sure you haven't experienced breakthrough.
Others on this forum have more experience than I with "helper drugs" to manage the drop in your WBC if that is the primary issue. But for "low" platelet count there is no option but to reduce the peg.
Approximately 25% of patients with genotypes 2 or 3 do not achieve an RVR (UND @ week 4) but achieve undetectable HCV RNA between Weeks 4 and 12. It is important to recognize that only 49% of patients with this response achieve an SVR.
ANC refers to the percentage of neutrophils (white blood cells that fight infection) and cells that will become neutrophils multiplied by the white blood count (WBC).
ANC below 2000 is considered to be neutropenia
ANC between 1000-1500 fairly low risk of infection.
ANC between 500-1000 - moderate risk of infection
Best of luck with your treatment.
Hector
Good to see you have responded to treatment. You've been undetectable for a while now, so reducing your dosage of peg stepwise should not be an issue. If possible it would be helpful to have a viral load test done after the reduction to make sure you haven't experienced breakthrough.
Others on this forum have more experience than I with "helper drugs" to manage the drop in your WBC if that is the primary issue. But for "low" platelet count there is no option but to reduce the peg.
Approximately 25% of patients with genotypes 2 or 3 do not achieve an RVR (UND @ week 4) but achieve undetectable HCV RNA between Weeks 4 and 12. It is important to recognize that only 49% of patients with this response achieve an SVR.
ANC refers to the percentage of neutrophils (white blood cells that fight infection) and cells that will become neutrophils multiplied by the white blood count (WBC).
ANC below 2000 is considered to be neutropenia
ANC between 1000-1500 fairly low risk of infection.
ANC between 500-1000 - moderate risk of infection
Best of luck with your treatment.
Hector
I am geno 1b since 1980, UND since week 8 (acctually somewhere between week 4 and week 8, I did the bt on week 4 and was detectable and then on week 8 and found UND since then.
What is ANC ? I don't see that I made this test till today, might be another name for it ?
Many thanks for the valuable info.
Jack
What is ANC ? I don't see that I made this test till today, might be another name for it ?
Many thanks for the valuable info.
Jack
Jack, your chances of SVR are affected by many factors...
What genotype are you? Type 1, I assume.
When did HCV RNA become undetectable? If the virus is not undetectable and you reduce meds, than you risk either prolonging your treatment or failing treatment because of viral breakthrough.
Here is some info on how to cut back your meds while preventing "breakthrough" from Dr. Mitchell Shiffman, one of the leading researchers in the field of effective HCV treatment.
"Understanding HCV Nonresponse and Identifying Candidates for Retreatment"
..."It is difficult for many patients to tolerate even the standard duration of peginterferon alfa and ribavirin therapy. Many studies have suggested that at least 20% of patients have adverse events that are severe enough to require either a reduction in the dose of peginterferon alfa and/or ribavirin, a temporary treatment interruption, or a permanent discontinuation of treatment.[22,23] Staying on full doses of these medications for another 24 weeks is often more than many patients can tolerate. One strategy to enable patients to remain on treatment longer is to reduce the doses of ribavirin and/or peginterferon alfa by small increments. This will frequently ease the adverse events of these medications and enable patients to remain on treatment longer. Several studies have now demonstrated that mild reductions in the doses of either peginterferon alfa and/or ribavirin will not adversely affect the chance of achieving SVR, especially if this strategy is employed after the patient achieves undetectable HCV RNA.[15,24] By contrast, interrupting treatment for more than 7 days because of adverse events leads to breakthrough and relapse.[24] Therefore, it is the recommendation of this author to reduce ribavirin stepwise by 200 mg every 2-4 weeks until adverse events either resolve or are tolerable. Peginterferon alfa-2a can be reduced from 180 to 135 µg/week and peginterferon alfa-2b from 1.5 to 1.0 µg/kg/week. Neither peginterferon alfa nor ribavirin dosing should be interrupted unless the adverse event is particularly severe and there is a concern for patient safety. Whenever the doses of peginterferon alfa and ribavirin are modified or temporarily interrupted, HCV RNA testing should be performed again to ensure that breakthrough has not occurred."
15. Reddy KR, Shiffman ML, Morgan TR, et al. Impact of ribavirin dose reductions in hepatitis C virus genotype 1 patients completing peginterferon alfa 2a/ribavirin treatment. Clin Gastroenterol Hepatol. 2007;5:124 129.
22. Pegasys [package insert]. Nutley, NJ: Roche; January 2004.
23. PegIntron [package insert]. Kenilworth, NJ: Schering Corporation; February 2007.
23. Shiffman ML, Ghany MG, Morgan TR, et al. Impact of reducing peginterferon alfa 2a and ribavirin dose during retreatment in patients with chronic hepatitis C. Gastroenterology. 2007;132:103 112.
24. Shiffman ML, Salvatore J, Hubbard S, et al. Treatment of chronic hepatitis C virus genotype 1 with peginterferon, ribavirin, and epoetin alpha. Hepatology. 2007;46:371-379.
By the way, your platelet count should not cause you any problems. Although different doctors have different counts that they are comfortable with. For many of us cirrhotics our platelets are lower than yours are now when we are not on treatment. My platelet count was in the 30k-40k range most of the time. I suffered no adverse effects such as bleeding in any manner.
What are white blood cells?
White blood cells, also called leukocytes, are cells that your body makes to help fight infections. There are several kinds of white blood cells. The two most common types are lymphocytes and neutrophils. Neutrophils are also sometimes called granulocytes or polymorphonuclear leukocytes (PMNs or "polys").
A normal WBC is in the range of 4,000 to 11,000 cells per microliter (mm3). How is your ANC? Is he worried about infection?
In the end it is up to your doctor as to what counts he/she is comfortable with.
If you have undectectable virus at this point, reducing meds in the manner stated above shouldn't be an issue. If you still have virus and you are beyond week 20 then you may jeopardize becoming undetectable by week 24, thus failing treatment.
Best of luck with your treatment.
Hector
What genotype are you? Type 1, I assume.
When did HCV RNA become undetectable? If the virus is not undetectable and you reduce meds, than you risk either prolonging your treatment or failing treatment because of viral breakthrough.
Here is some info on how to cut back your meds while preventing "breakthrough" from Dr. Mitchell Shiffman, one of the leading researchers in the field of effective HCV treatment.
"Understanding HCV Nonresponse and Identifying Candidates for Retreatment"
..."It is difficult for many patients to tolerate even the standard duration of peginterferon alfa and ribavirin therapy. Many studies have suggested that at least 20% of patients have adverse events that are severe enough to require either a reduction in the dose of peginterferon alfa and/or ribavirin, a temporary treatment interruption, or a permanent discontinuation of treatment.[22,23] Staying on full doses of these medications for another 24 weeks is often more than many patients can tolerate. One strategy to enable patients to remain on treatment longer is to reduce the doses of ribavirin and/or peginterferon alfa by small increments. This will frequently ease the adverse events of these medications and enable patients to remain on treatment longer. Several studies have now demonstrated that mild reductions in the doses of either peginterferon alfa and/or ribavirin will not adversely affect the chance of achieving SVR, especially if this strategy is employed after the patient achieves undetectable HCV RNA.[15,24] By contrast, interrupting treatment for more than 7 days because of adverse events leads to breakthrough and relapse.[24] Therefore, it is the recommendation of this author to reduce ribavirin stepwise by 200 mg every 2-4 weeks until adverse events either resolve or are tolerable. Peginterferon alfa-2a can be reduced from 180 to 135 µg/week and peginterferon alfa-2b from 1.5 to 1.0 µg/kg/week. Neither peginterferon alfa nor ribavirin dosing should be interrupted unless the adverse event is particularly severe and there is a concern for patient safety. Whenever the doses of peginterferon alfa and ribavirin are modified or temporarily interrupted, HCV RNA testing should be performed again to ensure that breakthrough has not occurred."
15. Reddy KR, Shiffman ML, Morgan TR, et al. Impact of ribavirin dose reductions in hepatitis C virus genotype 1 patients completing peginterferon alfa 2a/ribavirin treatment. Clin Gastroenterol Hepatol. 2007;5:124 129.
22. Pegasys [package insert]. Nutley, NJ: Roche; January 2004.
23. PegIntron [package insert]. Kenilworth, NJ: Schering Corporation; February 2007.
23. Shiffman ML, Ghany MG, Morgan TR, et al. Impact of reducing peginterferon alfa 2a and ribavirin dose during retreatment in patients with chronic hepatitis C. Gastroenterology. 2007;132:103 112.
24. Shiffman ML, Salvatore J, Hubbard S, et al. Treatment of chronic hepatitis C virus genotype 1 with peginterferon, ribavirin, and epoetin alpha. Hepatology. 2007;46:371-379.
By the way, your platelet count should not cause you any problems. Although different doctors have different counts that they are comfortable with. For many of us cirrhotics our platelets are lower than yours are now when we are not on treatment. My platelet count was in the 30k-40k range most of the time. I suffered no adverse effects such as bleeding in any manner.
What are white blood cells?
White blood cells, also called leukocytes, are cells that your body makes to help fight infections. There are several kinds of white blood cells. The two most common types are lymphocytes and neutrophils. Neutrophils are also sometimes called granulocytes or polymorphonuclear leukocytes (PMNs or "polys").
A normal WBC is in the range of 4,000 to 11,000 cells per microliter (mm3). How is your ANC? Is he worried about infection?
In the end it is up to your doctor as to what counts he/she is comfortable with.
If you have undectectable virus at this point, reducing meds in the manner stated above shouldn't be an issue. If you still have virus and you are beyond week 20 then you may jeopardize becoming undetectable by week 24, thus failing treatment.
Best of luck with your treatment.
Hector
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