hgb wbc ??

[spcecst2]

I would like anyone who has experience with rescue drugs ie procrit, neulasta etc… for low hgb/wbc to please take a sec and help me out, I’ve never taken anything during my treatments but am seriously thinking about it now, I have read articles before that suggested that people on rescue drugs during treatment did better with SVR!! My pre treatment hgb 15.5 wbc 6.8 now in the middle of 30 weeks hgb 11.4 wbc 2.5, (I always take my cbc the day before my shot so the numbers could be lower during the week) if you’ve used rescue drugs could you please tell me your normal numbers (prior to treatment) how low your number got  and what your number was after the rescue drug and male or female only because there are different ranges? Did the rescue drug make that much of difference in the way you felt? Did anyone do rescue drugs with the type of numbers I have? I’m trying to get a feel cause I’m pretty much going 72 weeks even though I got the rvr! The doc asked me if I wanted to do anything about it months ago and I said I’d just try to tuff it out plus I have to see chemo doc! And Procrit has some side effects!!
Peace Love and Merry Christmas! And Peace Love and Rock and Roll!

[jmjm530]

It's not the rescue drugs that make for better SVR figures, it's the fact that the rescue drugs help with compliance, i.e. less dose reductions. Your numbers look fine and can't see why you would want rescue drugs which come with their own sfx profile and risks. BTW WBC isn't as important as the WBC fraction called ANC (absolute neutrophils). Unless yours is below 500 (which I doubt) many doctors wouldn't consider a rescue drug. My ANC dropped to 320 during tx and no rescue drugs and no dose reductions. I had a similar hgb to yours during tx but I needed Procrit to keep it in the 11's.

-- Jim

[spcecst2]

I know about the compliance, I'm talking about articles I read that talked about statiscally higher SVR with rescue drugs because of the benifit of the rescue drug, today when I was at work (which s*%ked) I starting thinking about those articles and weaning off and other things and said to myself maybe keeping the host immune system at it's peak helped those people! So I'm thinking about a different reason for rescue drugs besides being able to just keep taking 180/1200!! The doctor seemed to think that uping my hgb would keep me from getting winded! My ANC is over 1000 I keep track of all those numbers cause thats what helps fight infection! Thats why I'm asking this question to see how people benifited?

[jmjm530]

space: I'm talking abot articles I read that talked about statistically higher SVR with rescue drugs because of the benefit of the rescue drug.
----------------
I'm unaware such a study exists, but please surprise me :) You are aware of the recent "Black Box" warnings on Procrit. Also, if your hgb goes up too much there can be cardiac issue.

-- JIm

[spcecst2]

The info I read was part of the results from studies about treatment and i didn't save them for that and have so much junk saved I've tried to find the reference! I know the side effects, I have plenty of life insurance! I just would like to have some real life numbers from people!

[jmjm530]

Side effects aside, I've never read a study that suggested Helper Drugs had any positive influence on SVR other than to help compliance. That was my main point.

Just don't want you to go down that road without confirming that you didn't misread the article, which if I were a betting man, I'd bet you did.

All the best,

-- Jim

[wyntre9]

My numbers look like yours.

Pre-TX WBC was 5.9, HgB was 14.7 and ANC was 3.7.

Less than a month into TX WBC was 1.7, HgB was 11.5 and ANC was 0.8.

WBC and ANC were flagged as ALERT on the lab report.

My Dr.  made me see a hemotologist immediately and started me on neupogen.
I've been taking it twice a month for the past 52 weeks.  My WBC and ANC never rose close to their pre-TX levels untill last month when I was on antibiotics for a couple of weeks.

My Dr. was very concerned with low WBC and ANC.  I hate taking the neupogen but he says it has kept those numbers from tanking to the point meds would have to be reduced.

HgB has nevr dropped below 11.  Although that's a large decrease compared to my pre-TX numbers, procrit has never been suggested.  I understand it's not offered until HgB drops below 10.

wyntre

ps - I'm on the 72 week extended TX, too.

[spcecst2]

Thanks here is a small note I found while looking for reference that I didn't read!!!!!!!!!!!!!1

Regarding the timing for when to start epoetin alfa in patients with HCV therapy-associated anemia, most study protocols have used a hemoglobin level of 12 g/dL as a threshold for starting epoetin alfa. One expert recommends starting epoetin alfa 40,000 U sq weekly for hemoglobin levels less than 12 g/dL in men and less than 11 g/dL in women [14]. In our opinion, initiating epoetin alfa for a hemoglobin less than 12 g/dL seems reasonable, especially if the patient has anemia-related symptoms such as fatigue or dyspnea. After starting epoetin alfa, if the hemoglobin increases less than 1 g/dL during the next four weeks, we recommend increasing the dose to 60,000 U sq weekly. If there is still less than 1 g/dL increase in hemoglobin during the subsequent month, then epoetin alfa support should be stopped. For those with acceptable response, epoetin alfa should be held while the hemoglobin level exceeds 16 g/dL in men and 14 g/dL in women.

Guidelines from the American Society for Clinical Oncology [15] state that epoetin alfa should definitely be started for hemoglobin less than or equal to 10 g/dL, and that clinicians should consider the clinical circumstances if the patient has a hemoglobin level between 10 and 12 g/dL.

[jmjm530]

I don't dispute that recommendation ( I actually started epo at hgb 11.4) but that is why I specified "mid treatment" in my previous post.

My pre-tx hgb was 14.8. Two weeks later it was 11.4 and I ended up in the ER with anemia.

The reason for the ER wasn't because of the absolute number (11.4) but because of the rate of drop (over 3 points in two weeks). Later in treatment -- mid treatment -- I was functioning fine (as far as anemia went) with hemoglobin in the 11's. I think this is consistent with the article you quote and with what I posted. What happens over time is that the body adjusts to lower levels of hemoglobin.

-- Jim

[wyntre9]

It's only in retrospect that I realize why I've felt so crummy for the past year.  I didn't know a thing about anything hep related, much less anything about the lab reports.

My HgB dropped more than 3 points in 3 weeks.  Reading that you ended up in the ER coz of that (after 2 weeks) helps put some things in perspective for me.

Despite many posts that might indicate the contrary (*LOL*), I'm not a huge complainer and am more the sort of person that keeps thinking either everything's gonna improve quickly or things aren't as bad as they seem.

Granted, a lot of other people have had much bigger decreases in blood counts than me, but reading that a similar HgB drop caused severe SX in you somehow makes me feel better.

Not that I'm glad you ended up in the ER, you understand!  :)

Boy, I can't wait for the next 20 weeks to be over.  I'm ready for hibernation.

wyn

[spcecst2]

What do they call rescue drugs in official conlusions found in studies? I'm not using the right search term? Example would be if they said patients using "rescue drugs" had higher svr rate? I'm not trying to prove any points I am just looking for answers!!

[jmjm530]

Not sure of your question, but if you're asking why Procrit and Neupogen are called "rescue drugs" it's because they can potentially "rescue" the patient from the side effects of anemia and neutropenia (low ANC) respectively -- and in a sense "rescue" them from terminating tx in some cases. Two "Google" searches you might try are "anemia epo SVR" or "rescue drugs hcv SVR".

Nothing to prove on either end -- I just want to make sure that if you're going to base a decision to go on rescue drugs on the premise that the rescue drugs -- in and of themselves foster SVR -- that your premise is correct. I don't think it is.

-- Jim

[traveler65]

My starting hgb was 15.3. At week 7 I was down to 9.2. My doc waited until week 8 to start me on 40K of procrit at hgb of 9. I continued to go down so they upped it to 60k at week 9. That kept me steady for a while, but I started to drop again and at week 14 I was at 7.4. I ended up stopping the riba (1000 daily) for one week and getting a transfusion. This helped tremendously, my hgb went up over 12. I re-started riba at 800, but even with procrit by the time I got to 24 weeks my hgb was down to 8.8. Luckily, as a 2B I only had to go 24 weeks. My 6 months PCR is coming up in January. I was UND at 4, 8, & 16 weeks during treatment and 6 weeks post. If I have relapsed I don't know what I will do as the procrit did not work for me.
Good Luck

[Proactive]

Speaking about black box warnings, anyone catch this from last week.
"AP
Amgen Discussing Aranesp Label Changes
Friday December 7, 8:32 am ET  
Amgen Discussing Aranesp Safety Label Changes With the Food and Drug Administration


THOUSAND OAKS, Calif. (AP) -- Biotechnology company Amgen Inc. said late Thursday it is discussing potential safety updates for its anemia drugs with the Food and Drug Administration and there will be a panel review during the first quarter.
ADVERTISEMENT


The drugs are part of a class of drugs called erythropoiesis stimulating agents, or ESAs, used to treat anemia in chemotherapy and kidney-failure patients. They include Aranesp and Epogen, made by Amgen, and Johnson & Johnson's Procrit.

Earlier this year, the FDA issued requirements for stronger warnings on the drugs and asked for additional studies. The FDA issued a "black box" warning on the drugs, the most serious warning a drug can carry, emphasizing that cancer patients had increased risk of death and showed accelerated tumor growth when treated with high doses of the drug.

The company is conducting studies to further determine the possible safety risks.

The Centers for Medicare and Medicaid Services changed the reimbursement policy for Aranesp and other drugs in the same class during the quarter. Now doctors will only be paid for using a low dose of the drug.

Additional safety label changes will likely be based on data from a breast cancer patient study and follow-up data from a cervical cancer patient study, Amgen said.

The FDA's Oncologic Drugs Advisory Committee will meet during the first quarter as part of its ongoing review for ESA therapies, the company said."

[spcecst2]

Someone could have argued that your premise for your treatment plan was in correct! I’m not naïve enough to believe that about the rescue drugs without some more info, as I clearly stated the doctor had previously asked me if I would like to visit the chemo doc for evaluation earlier in my treatment of which I have several years of experience and many years of researching, I just happened to be reading some results and conclusions about hep c treatments and noticed those findings hidden in the documents and even showed them to my wife because of my apprehension of doing rescue drugs, I’m just looking, and thinking with an open mind about a very complicated problem!

[wyntre9]

That sounds like a huge drop;  6 points in 7 weeks.

I can't imagine getting that low as it's been difficult enough for me with the measly 3 point drop I've had.

Congrats on your early UND and best of luck with SVR.  Sounds like you're gonna hear those magic words very soon.  

wyntre

[jmjm530]

I think you're making something simple too complicated. Either a study exists that shows that Helper drugs -- in and of themselves -- can help SVR (as opposed to helping compliance) or the study doesn't exist. This has nothing at all to with any premises of my treatment. I think I've said all I have to say on this subject.

-- Jim

[spcecst2]

I was just asking if people would share their numbers with me!

[GoofyDad]

FWIW, I started procrit at 11 from a baseline of 16.5. Ended up going down to 7.0 and spent most of tx in 8's and then 9's.

I think the action at play in the 'rescue drugs help SVR' concept is that by needing the Procrit you are showing that your body is getting a whallop from the Riba. Don't need procrit? Maybe you're not getting whalloped hard enough. Whallop some more until you need procrit. We don't all matabolize and clear the riba at the same rates.

I'ts kinda like drinking enough until the ugly girls start looking pretty.Or maybe not....

PS -  a safer approach might be to ribafy right to the threshold of needing the procrit... just random musings....

[jmjm530]

Goofy: think the action at play in the 'rescue drugs help SVR' concept is that by needing the Procrit you are showing that your body is getting a whallop from the Riba.
-------------------------------------------------
That would only be the case if the "low SVR" group didn't need Procrit. I don't believe the studies were structured that way. What happened is that two groups were compared -- those where Procrit was made avaliable. And those where Procrit was not made available. The difference was in compliance, not hgb drop.

I do agree however, with amping up ribavirin until the non- Procrit "theshold" is met and then adding Procrit until the maxium Procrit threshold is met. That is if you decide it's in your best interest to fight as agressive as possible  and you and your doc accept the risks that go with the xtra toxicity.

-- Jim

[jmjm530]

"...In summary, the use of EPO significantly decreased the frequency of anemia, and the need for RBV dose reductions and premature discontinuations."

http://www.hivandhepatitis.com/2005icr/aasld/docs/112305_a.html

[jmjm530]

Let me rephrase my second post back.

I think your point valid in a population where everyone was offered Epo, but only a subgroup accepted it. That subgroup no doubt had more anemia and therefore and argument could be made they had better ribavirin absorption. My point was simply that the studies in question were not structured that way and therefore compliance was the deciding factor.

-- Jim

[FlGuy]

Usual hgb around 16.  Going into tx2 we had a target of maintaining 11-12 with Aranesp.  Hemo did a good job of modulating and stayed in the vicinity of 11.2 - 11.6 for most of tx.  Main reason was to maintain some function so that I could work.  Low end target for ANC's was 500, but never go there - bounced around from 600-1100.   Prior tx used neupogen, but then target for ANC's was 1000.  If it comes to low ANC's, I'd recommend more frequent Neupogen rather than less frequent Neulasta (pegylated Neupogen), Neulasta is nasty in the way of sx's.  Neupogen almost un-noticeable.  I've never been under the impression that aranesp/procrit/neup aid in tx, other to help one stay on med schedule.

[nygirl7]

I couldn't have made it through treatment without the Epogen, no way.  I went from 15+ down to 9 in just over ONE week.  It was physically devastating. I didn't know a human being could feel like that and live.  It wasn't just the "number" per se...but that it happened so incredibly fast.

Your body will learn to live in the 11s with no problem eventually - taking it once a week got me up into the mid 10s and I was ok after a while with that.  I guess your body is just able to do about anything, it's really so cool.

I am a big believer in using the stuff space - it really did help me a LOT.

[spcecst2]

Thanks for the info!! Merry Christmas to all and to all a good day!!!!!!!!!!!

[Lady Lauri]

  You said that PERFECT...............  "It was physically devastating. I didn't know a human being could feel like that and live."

  Mine dropped @ 4 points in 2 weeks and I kept thinking I was being a woos! " I can't feel THIS bad already???" Total body shock!
Hence the reductions as can't do the epogen, procrit. I would never make it thru 48-72 weeks!

In my no where near as 'educated' in all this as everyone above.......I just don't see why trials don't get rescue drugs as per the 'compliance' factor making a difference in the outcome??

                                                                                                LL