Low Neutrophils

[Imwesthamtillidie]

Hi all,
I've just started retreatment (72 weeks) and am only into my 3rd week.My neutrophils dropped to 0.4  so my dose of interferon was reduced from 180mg to 135 mg but my ribavarin has stayed the same. On my second blood test my neutrophils had risen to 0.6 (still low ). Im now being told that I will be staying on 135 mg of interferon for the duration of tx. Does anyone know roughly how much my chances of success have been reduced by.

Regards
imwesthamtillidie

[IAmTheWalrus]

The Pegasys is the culprit for lowering white blood cells. Ribavirin kills the red ones.

The whole question of treatment duration vs. success odds is kind of up for discussion due to discoveries about other factors such as insulin resistance and genetic factors. More important than your treatment duration is the rate at which the virus becomes undetectible.

Since you say that you are on 72 week TX I have assumed you are genotype 1.  But, usually, the decision to extend from the standard 48 weeks TX is not made until agter 12 weeks of treatment. The conventional wisdom has been that if the virus is undetectable by week 12, then the standard 48 weeks should be enough.

But more importantly, the viral load test results at 4 weeks is the most important in predicting successful treatment. If you had an UND result at 4 weeks, then there is probably no reason I can think of to extend to the longer treatment. Also, a UND result at 4 weeks is a good predictor of SVR.

I do not know of studies offhand that would give good information on the subject, but most think that early reductions in Peg or Ribavirin are more detrimental than later reductions, the main goal being UND at 4 weeks.

Brent

[Imwesthamtillidie]

I finished tx the 1st time 2 years ago. Then I was undetectable at 12 weeks and 48 weeks but the virus return at 24 weeks post tx. This is my 2nd time and obviusly I will only get to do the whole course if have at least a 2 log drop at twelve weeks.My viral load was 57,000 3 years ago at the start of tx. This time it  is 252,000.At my hospital they dont give 4 week tests  (Imfrom England).

John

[comeagain]

I don´t know if your doc is up to date with treatment .
Can you get a second opinion.

I also did a dose reduction once on my second tx 180to 135 pegasys due to low neutrophils 0.6,  6days in treatment.
I couldn´t reach my regular doc it was another one there I first refused to do any dose reduction. But when threatened with taking me of treatment I finally agreed.
Didn´t liked it though since I know its crusial to try to stay on full dose in the beginning specially.

My neutros  went up to 0.9  the week after  and I didn´t had do do any more reduction after that although once they were down to 0.3 week 40 that was otherwise the stayed between 0.5 to 0.7most of the time.

At one point when I was really sick they went up to 1.6,and I was so sick thought I was gonna die couldn´t swallow and had high high fever for several days.

My ordinary doc had read some study that low neutrophils for HCV patients wasn´t that alarming contradictionary to canser patients and he set the limit to 0.3 before any dose reduction.
( he dared to go out of the box)

Google neutrophils and HCV and see if you can find that study to show your doc.
try to get a 4 week pcr aswell .

Do everything you can to upper your ods without have to quit tx read a post from mikesimon about vitamin D maybe that could be something but always check with your doc before doing anything ( best check with more than one doc if possible)

All the best

ca

[Imwesthamtillidie]

Thanks ca and Brent

Regards

Johnm

[IAmTheWalrus]

Sorry to hear about the late relapse on the 1st treatment. I don't know if the same wisdom applies to 2nd time.

I did a long TX (84 weeks), but relapsed at 12 weeks post TX. During TX my liver condition not only did not deteriorate during TX, but improved. I am hoping that this has bought me the time to wait for newer PI drugs currently in tirals here.

I guess I am saying that even though the goal of SVR is not reached, there can be some benefit.

Just a quick search came up with a Swiss study on retreatment of patients initially treated with Peg Intron (alpha 2a) that shows some success using a longer 72 week TX with Pegasys (alpha 2b)

http://www.medicalnewstoday.com/articles/146933.php

Even here it looks like the odds are increased from 8% to 16% with the longer TX.  If you are UND at 12 weeks, the odds get much better. The odds then look very similar to first treatment on Pegysys for a 48 week period (around 50%). The way I read it, if you are UND at 12 weeks, and treat for 72 weeks, you have the basic 50% odds that TX naive patients have going into SOC (48 weeks) on Pegasys. The reduced dosage definitely would reduce the odds of success but I know of no data that would predict how much given your setting of retreatment using Pegasys after failure on Peg Intron.

Best wishes to you

[Marcia2202]

It would be so good if you could talk your doctor into doing a 4 week PCR. All studies are based on this important marker. You could show some of these to your doctor to argue your point. The 4 week PCR is the best predicator to outcome of tx.