treatment with low platelet count

[Captnj]

Does anyone know if you can still get treatment with a low platelet count?
Gen 1a  Stage 4 grade 2
Platelet 85

[cam76]

hi i started at low platets in the 70s and i did finish at haft dose and und

[saadali]

Dear My wife has hepatitis c . Everything was going good but had a bad news today because of the blood test. Her platelets have gone to down 14. extremely worried she had only 2 tx left to complete 24 pegagus inj. Her PCR got negative after 2 months of treatment and we were about to celebrate finishing of her treatment. She is 24 and there is no cirrhosis. please advise

[mikesimon]

http://www.ncbi.nlm.nih.gov/pubmed/19030197?dopt=AbstractPlus

World J Gastroenterol. 2008 Nov 14;14(42):6467-72.
    
Antiviral therapy in hepatitis C virus cirrhotic patients in compensated and decompensated condition.
    Iacobellis A, Ippolito A, Andriulli A.

    "Casa Sollievo della Sofferenza" Hospital, IRCCS, viale Cappuccini 1, San Giovanni Rotondo 71013, Italy. a.***@****.

    The main goals of treating cirrhotic patients with antiviral therapy are to attain sustained viral clearance (SVR), halt disease progression, and prevent re-infection of the liver graft. However, while the medical need is great, the use of interferon and ribavirin might expose these patients to severe treated-related side effects as a large proportion of them have pre-existing hematological cytopenias. We have reviewed potential benefits and risks associated with antiviral drugs in patients with liver cirrhosis, due to hepatitis C virus (HCV) infection. In cases presenting with bridging fibrosis or cirrhosis, current regimens of antiviral therapy have attained a 44%-48% rate of SVR. In cirrhotic patients with portal hypertension, the SVR rate was 22% overall, 12.5% in patients with genotype 1, and 66.7% in those with genotypes 2 and 3 following therapy with low doses of either Peg-IFN alpha-2b and of ribavirin. In patients with decompensated cirrhosis, full dosages of Peg-IFN alpha-2b and of ribavirin produced a SVR rate of 35% overall, 16% in patients with genotype 1 and 4, and 59% in those with genotype 2 and 3. Use of hematological cytokines will either ensure full course of treatment to be accomplished with and prevent development of treatment-associated side effects. Major benefits after HCV eradication were partial recovery of liver metabolic activity, prevention of hepatitis C recurrence after transplantation, and removal of some patients from the waiting list for liver transplant. Several observations highlighted that therapy is inadvisable for individuals with poor hepatic reserve (Child-Pugh-Turcotte score >= 10). Although SVR rates are low in decompensated cirrhotics due to hepatitis C, these patients have the most to gain as successful antiviral therapy is potentially lifesaving.

[Captnj]

I'm not in any trial. I'm still waiting to talk to the transplant docs and see if they think I will be able to do any treatment before transplant. That's what really ***** for me is that I think I'm just going to have to sit around and do nothing until I get sicker and then get a transplant. Anyway, I'll keep y'all up on what the docs say. I started antidepressants so maybe they will take the edge off and everyone keeps telling me to just focus on 1 day at a time. I have ultrasound set up for tomorrow.

[can-do-man]

Also the trial requires an ultra sound, But my Hepo doesn't much care for the ultra sound and insteads has his patients have either a CT scan or MRI. Sense i had just had a upper gi and CT scan schering saw it is way and decided to drop the ultra scan requirement for patients that had the scan.

[can-do-man]

I am in the relapser trial with boceprevir, and yes it states platelet level cut off is 100,000. But schering has a 10% lead-way so they on their own will let you be at 90,000. But the final decision rest with your hepatologist if he/she feels its safe at a lower level schering will go with it. Mine had no problem at 85,000 would he went to 80,000??? Not sure but i believe he would have.

This was a major concern for me so i had called the 888 number for the trial at clinicaltrials and then confirmed this info with my doctor. A CBC 30 days before my screening had me at 80,000. All become a mute point because the day of my screening my level was right at 100,000. Best to you

cando

[Bill200]

What trial did you get in?  Both Teleprefvir and Boceprefir require greater than 100,000.

[Captnj]

Waiting to get an appointment with transplant doc in New Orleans. I will talk to him about treatment then. Thanks for the support and I'll keep y'all up on what they say.

[can-do-man]

Also a stage 4 grade 2. My platelets bounce around between 80,000 and 100,000 just started a trial for relapsers, 85,000 would have just got me by.. Though you will need a good hepatologist to get you in, BTW from hepos i have talked with including my own 10% cure rate is a little low.... Best to you

[GoofyDad]

I started with platelets=111 - and SVRed with no dose reductions. Platelets bounced between 50-70K. Good luck.

[sldb]

plat ct of 85,000 is not to low to treat. I started tx with a 123,000 plat ct that dropped to 50,000 during tx.  My hep said he did not get concerned til it gets down to the 30,000 range. Is your cirrhosis compensated or decompensated? Have you seen a hepatologist yet?  

[Captnj]

my local doc said for me to go to the liver transplant doctor and get established with him.
He knows them and he said he doesn't believe that they will want to try treatment until after I have a transplant. Anyway more waiting I guess. I'm going to try to get in to see the transplant doc asap. Thanks for all the input. I'll keep y'all up on what the docs say.

[mikesimon]

A platelet count of 85,000 should not preclude treatment.

[evangelin]

Yes , it varies from person to person as to how much the interferon knocks them down.  My husband is on week 25 of tx and his have dropped from 68 to 58 but he is still considered just fine.  He has had bigger fluctuations than that when not even treating. A knowledgable Dr. who treats a lot of hep c patients will let them go pretty low without too much concern.  I dont think they get very concerned until it goes to the lower 20's. If your platelets are in the 80's, it is probably a sign of deteriorating liver functions so you don't want to wait for things to get worse before starting tx.  Not all Doctors are equal.  You want someone that deals with lots of patients and can treat you agressivly the first time so hopefully you can put this behind you.  I haven't read your profile so I am just assuming that you haven't tried treating before.
Best wishes,
Ev

[Trinity4]

This was posted by HectorSF in October.  I think it pretty much sums it up.

A low platelet count in a symptom of cirrhosis caused by an enlarged Spleen (Spleenomeglia) which captures the platelets are causing them to die. At the present time clinical trials are being conducted on a drug that will raise platelet counts. It is not on the market at this time.

Each person responds differently to treatment based on many factors including the degree of liver damage. The only way to know for sure what will happen, is to start treatment with an experienced doctor who understands the complexity of treatment with patients with advanced liver disease. Hopefully your platelets will only drop moderately and then stabilize themselves (when your platelet count gets down to the 20ks even the most experienced doc will stop treatment).

Remember as your liver disease advances your chances of SVR drops especially in Stage 4. Persons with cirrhosis and genotype 1 typically have about a 10% chance of SVR with current treatment meds. I believe it is worth trying. I tried treatment but it didn't work for me. (Null Responder).
Within 12 weeks you will also know if you respond to current treatments or you may have to wait until 2011, when the new drugs should be available on the market which now seem to improve the percent of patients who achieve SVR. Hopefully it will work for us with advanced liver disease as well.