reduce pegs for stable wbc

[toby47]

Any body reducing interferon to help raise wbc. I'm doing 3 shots a week of neupogen and still have 9 more weeks ,or is it better to keep doing shots?In the studies does it say anywhere if you can stabilize your wbc a little, will it stay high enough to at least reduce one of the shots.Or is it too risky to reduce inf, everybody talks about riba for hgb, but what about the pegs.

[flcyclist]

It sounds like we're in similar situations.  My GI referred me to a Hemotologist due to low ANC levels.  It's the Hemo's job to monitor the blood levels to keep them in the proper range by giving rescue drugs as needed.  You might be able to drop down to 2x per week with little influence on the ANC.  Not sure whats going on with the Hgb since you also mentioned Procrit.  

You should feel comfortable asking your Hemo specific questions if the staff can't address them.  When it comes to talking about dose reductions, you should be discussing this with your GI or Hepatologist who should be guiding you through trt.  

[pcds]

How would you take things in your own hand?  I have not always followed the exact instructions from the doc.  played alittle with it an increased dosage.  But how are you going to manage your WBC?  If you need 2 shots of neupogin per week you need the docs to order it.  If you increase your peg then your WBC will only go lower without the increased neupogin.  I went into neupogenic fever which lead to all kinds of problems with my sodium level and was hospitalized but I was on 3 therapy, that ended 2 weeks ago.  

[toby47]

Thanks for your reply 's, I still don't know what to do. I've come so far I hate to jeopardize my outcome with only 10 wks to go.

[flcyclist]

Your absolute neutrophil count (ANC, GRAN or GR#) is .3 or 300 cell/uL.  Most doctors get concerned when it goes below 500 to 700 (.5-.7), but there's some debate regarding real risk of infection.  Mine is often down to .2 on Monday after Friday's Inf shot.  I do 2x per week neupogen and don't have any sides from it.  I'd prefer to do this rather than reduce the Interferon, but that is a discussion to have with your doctor.

orphanedhawk - thank you for posting that article.  I seen several references to drops in Hgb and SVR, but not ANC.  

[pcds]

My lab doesn't break out anc either but it can be figured out the the info there.  1.4 is low.  I went lower to .7 and my doc had me hold peg one week, did neupogen 2x in a week and went to 2.7.  Last peg 90 on friday. Tomorrow I get my CBC  I am very interested to know where I stand, since my HGB has been an issue too.  I have pay 100 per month for neupogin, 100 for procrit, 107 for peg and riba.  Your cost is very very high.   At least I'm on a 24 week regime.  Just wonder how all this dose reduction will play out.  I just don't want to go to hospital again for neutopenic fever or bedridden for hemoglobin of 8.  This anemia is the a central issue for us on triple tx and post triple.

I get weekly CBC.   I actually asked to 2x week CBC but my doc said I needed all the blood I have and it wasn't worth it to do it 2x week.

[toby47]

Wish I had confidence in my doctors.At the hemo's office its like your at Jiffy lube, in and out -- no doctors involved. Saw one once first day there 6 weeks ago.Its not right but maybe I need to take things into my own hands.

[toby47]

I'm  1a,und at 4,8 12 wk ,start wk 15 of 3xtx w/inc.I'm at the hemo's office. all the time and they don't do anc. What i get from them is wbc,lym,mid,gran.Yesterday's was wbc 1.4 and gran .3 In comparison two weeks ago labs showed wbc 1.8 and anc at .8 Maybe they should be letting the wbc go lower w/o neup.Just seems I'm there too often and its costing me 100 bucks a shot and a little less for procrit.So without anc count the above article doesn't help.Just seems like overkill to get a lab cbc and then there bloodwork.

[pcds]

It is not uncommon to reduce peg to raise WBC.  I did and still was undected at 4 and 12 wks.  I had serious WBC issues on neupogin.  Now at a reduced peg of week at 90 likely will go to 135 this friday, depending on tomorrows labs.  There is much more "messing around" with doses then when on SOC.  I am treating with physicians very familiar with these meds and currently treating 70 persons on triple therapy so they have experience which many do not.

[orphanedhawk]

It's hard to say without know when you were UND and other elements of your treatment. How low are your neutrophils?
My doc has me take it if they go below 750 but that may be specific to me.
I asked him to reduce the dosage of neupogen because the side effects were just too much, and he did. So that may be an option, too.
Read the research below.
Good luck
OH

Reduction in Neutrophil Count During Hepatitis C Treatment: Drug Toxicity or Predictor of Good Response?

Authors: Alvarez-Uria, Gerardo1; Day, Jeremy2; Nasir, Anisa2; Russell, Susan2; Vilar, F.2

Abstract:
Bone marrow suppression is a well-recognized toxicity of the treatment of hepatitis C virus (HCV). Reduction of the peginterferon dose because of neutropenia is common in clinical practice. However, reduction of peginterferon dose during the first weeks of HCV treatment is associated with failure to achieve sustained virological response.

The objective of this study is to investigate whether the fall of neutrophil count during hepatitis C treatment is associated with achieving sustained virological response.

We performed an observational study of patients who completed peginterferon and ribavirin treatment in an Infectious Diseases Department in Manchester, UK.

Of the 74 patients included in the analysis, 78% had genotype 2 or 3 hepatitis C and 15% had liver cirrhosis. Sustained virological response was achieved in 78% of patients. On univariate analysis, factors related to achieving sustained virological response were younger age, genotype 2 or 3, baseline neutrophil count, and fall of neutrophil count during treatment. Multivariate analysis showed baseline neutrophil count >3.5 × 103 cells/mm3 [odds ratio (OR) 5.7; 95% confidence interval (CI) 1.24-26.3] and a reduction of neutrophil count >60% (OR 4.5; 95% CI 1.03-19.9) to be independently associated with achieving sustained virological response. Neutropenia was not associated with an increased risk of infections.

In this observational study, higher baseline neutrophil count and fall of neutrophil count during the treatment of hepatitis C was associated with achieving sustained virological response. These findings could have important implications for the monitoring and management of HCV treatment with peginterferon if they are confirmed in other studies.

Document Type: Research article

Affiliations: 1: Monsall Unit, Department of Infectious Diseases, North Manchester General Hospital, Delaunays Road, Manchester, M8 5RB, UK, Email: ***@**** 2: Monsall Unit, Department of Infectious Diseases, North Manchester General Hospital, Delaunays Road, Manchester, M8 5RB, UK

Publication date: 2010-07-01