What to watch out for with Neupogen - WBC took a nosedive

[motheroffour]

Well at week 38 by H's whites took a nosedrive. Neuts below 300 after hanging at 700 for the entire time.  They were ever so slowly trending down, but took a dive into the danger zone - so Neupogen is being fedxed...other than possible bone pain anything to look out for?  What about shot timing, doc says take same day as interferon so he's on 1x per week Neupogen and have CBC run 5 days later?  Make sense or is there a more sensible schedule?  Is there an SOC yet for Neupogen in terms of dosing or regime?  Do you stop when the neuts come back up or is this a now to the end type of thing.  There's no way now any of us will get H to extend past 48.  He's convinced the drugs are starting to hurt him more than help him.  It will be interesting to say the least the next half year to see what happens to him.

[jmjm530]

If there have been more than five days between your last CBC and the day the Neupogen arrives, you might consider taking another CBC to deterimine if his absolute neuts rebounded on their own, as mine did from 320 to over 1000. Not recommending you delay the Neupogen per your doc's schedule, but if the logistics permit you to stay on that schedule, I'd try and squeeze in that extra CBC, the results of which should be available overnight.

-- Jim

[motheroffour]

Good point, they did bounce from 700 to 900 in early days of tx and one time from 500 to 700.  This is from CBC last Friday (he does shots on Sunday, CBCs on Friday) and it was under 300, so he could squeeze a CBC in tomorrow and know Friday before he takes shot this weekend.  That's why I wondered if this is a short term thing to get the numbers back up or if the docs just keep people on it if they fall below the magic 300.

[illo]

I don't have a clue about it other than I'm on it now.  My doc said to take it
at least 2 days after the interferon shot.  Don't know why.  Tired with the first 3 shots, OK with the 4th. Because I'm 112 lbs, he cut my Interferon a little.  It helps,  but I try to keep it up.  Wish I could tell you more.

[motheroffour]

Hummmm, H's medical office told him to take the Neup the same day as his Interferon and they confirmed that with me.  Why shouldn't you? Maybe the doc thinks just get the whammy out of the way and then you'll feel better rather than having 2 whammies per week.  I wondered about that...holy cow he could be flat on his back if the Neup makes you feel like you've been hit by a truck.  He's always alittle chilly and tired the day after his interferon.

[painterlady13]

I have been on neupogen since week12 , I am now at 44/48 . My Liver specialist was very adamant about me allowing a full 24 hours to pass between the Interfuron and the neupogen.  I take IFN on fri night and Neup on sat.  He said it had something to do with the IFN canceling out the full effect of the Neup.  I guess every doc's opinion is different.   I really haven't had any sides from the neup other than some mild bone pain in my shins.  and it has kept my WBC in the reasonablly normal range.  I hope it brings the wbc up quickly for ya.  good luck

[friole]

I agree with Painter.  wait at least 24 hours after the interferon shot to take the Neupogen.  They kind of counter act one another with the interferon destroying and the neupogen building blood cells.  My doctor said to do them 48 hours apart, but a lot here have been told 24 hours is fine.

That is sure late in treatment for the white count to drop so radically.  It works fast so, unless it comes on the day of your interferon shot, I would take it immediately.
frijole

[motheroffour]

Thanks everybody, I was kind of surprised it dropped so dramatically, also and so late in treatment, too. I think it caught the PA off guard, too because she called at 5:20 PM.  I got the labs in hand today and the paperwork indicates that they ran the test twice to validate the numbers so 328 he was (at least last week) down from 748 4 weeks earlier. His RBC have been sliding all along and I thought that's why the doc called but the RBCs went up over 11 after hanging at 10.7 since week 3.  He's stopping at the lab tomorrow AM so we'll know Friday if there was any bounce and I'm waiting for confirmation from the pharmacy that the Neup is approved and that they are overnighting, I can't imagine there would be a problem as it's been smooth sailing insurance wise so far.  In fact  his script was for the full 48 weeks of Interferon and Riba and it just gets automatically shipped every 3 months with no phone calls or anything.  I told H to split the shots by at least 24 hours so he just needs to decide if he wants to ruin his Sunday or ruin his Tuesday since shot night is Sunday night - LOL, my guess is he'll go for ruining his Tuesday.  Everything else is looking pretty good.  His platelets are still low, but to be expected.  His AST/ALT are well into the lower normal range now, Billi, INR/PT and Creat/Bun are still just a tad out of normal, but better than a year ago.  He would tell me to tell you all he feels great.

[orphanedhawk]

I go to a reknown heptology/research/liver clinic. I was told to do my interferon and neup shots at least 24 hours apart. I didn't ask why.    I do my CBC, take the neup later that day and the next day I take my peg shot.
    I find the heating pad is my best defense against the neup soreness.
         Good Luck