Low ANC and Platelets

Question

I am on week 20 of victrellis combo. past 3-4 weeks my platelets have dropped below 50 so doc has me on half dose peg and its holding in the upper 40s.  This week my ANC dropped to 0.7 lowest its been . I took Neuprogen shot 8 weeks or so ago got a fever for three days and Doc not crazy about me taking another shot..  I was undetectable at week 8 and 12 .. 
starting to worry now about half dose 90mg of pegasys I have been taking past two weeks and probably will this week too... anyone have an opinion on cutting the pegasys dose at this stage and the chances of keeping the virus undetectable forever...


thanks

HectorSF · Accepted Answer

As Will stated...Your doctor is following the recommend protocol from managing thrombocytopenia and Neutropenia caused by treatment drugs.

"HIGHLIGHTS OF PRESCRIBING INFORMATION
These highlights do not include all the information needed to use
PEGASYS safely and effectively. See full prescribing information for
PEGASYS.
PEGASYS (peginterferon alfa-2a)
Injection for Subcutaneous Use
Initial U.S. Approval: 2002

http://www.gene.com/gene/products/information/pegasys/pdf/pi.pdf

"2.4 Dose Modifications
If severe adverse reactions or laboratory abnormalities develop during combination PEGASYS/COPEGUS therapy, the dose should be modified until the adverse reactions abate. If intolerance persists after dose
adjustment, PEGASYS/COPEGUS therapy should be discontinued. Table 3, Table 4, Table 5, and Table 6 provide guidelines for dose modifications and discontinuation of PEGASYS/COPEGUS based on laboratory
abnormalities, patient’s depression status, and cardiac status.

Adult Patients

When dose modification of PEGASYS is required for adverse reactions (clinical and/or laboratory), initial dose reduction to 135 mcg (which is 0.75 mL for the vials or adjustment to the corresponding graduation mark for
the prefilled syringes) is recommended. Dose modification to 135 mcg per week can also be achieved by using a 135 mcg/0.5 mL strength disposable autoinjector. Dose reduction to 90 mcg (which is 0.5 mL for the vials or adjustment to the corresponding graduation mark for the prefilled syringes) may be needed if the adverse reaction persists or recurs. Following improvement of the adverse reaction, re-escalation of the dose may be considered [see Warnings and Precautions (5) and Adverse Reactions (6)]."

Table 3 PEGASYS Hematological Dose Modification Guidelines

ANC <750 cells/mm3 - Reduce to 135 mcg
ANC <500 cells/mm3 - Discontinue treatment until ANC values return to more than 1000 cells/mm3. Reinstitute at 90 mcg and monitor ANC.

Platelet <50,000 cells/mm3 - Reduce to 90 mcg
Platelet <25,000 cells/mm3 - Discontinue treatment"

Good luck.
Hector

orphanedhawk · Answer

I've been taking neupogen for low anc levels.
The first shot, 300 mg. wiped me out, everything hurt including walking.
The next week, I contacted my doctor in tears.
 He lowered my nuepogen to 150 mg. This amount I find tolerable.
If you don't want to lower the pegasys, ask about lowering the neupogen.
( Note: I'm doing SOC, not the triple tx)

willbb · Answer

When dose modification of PEGASYS is required for adverse reactions (clinical and/or laboratory), initial dose reduction to 135 mcg (which is 0.75 mL for the vials or adjustment to the corresponding graduation mark for the prefilled syringes) is recommended. Dose modification to 135 mcg per week can also be achieved by using a 135 mcg/0.5 mL strength disposable autoinjector. Dose reduction to 90 mcg (which is 0.5 mL for the vials or adjustment to the corresponding graduation mark for the prefilled syringes) may be needed if the adverse reaction persists or recurs. Following improvement of the adverse reaction, re-escalation of the dose may be considered [see Warnings and Precautions (5) and Adverse Reactions (6)].

willbb · Answer

yikes...let me try that again..

 is proper protocol if the absolute neutrophil count(ANC) is low to introduce procrit and /or sometimes reduce the amout of Peg. 

 meant to say  to introduce neupogen  for the ANC    not procrit

and neup is not prescribed for low plats   ..it is often a reduction in peg

willbb · Answer

It is proper protocol if the absolute neutrophil count(ANC) is low to introduce procrit and /or sometimes reduce the amout of Peg.

Your platelets are low ,however not usually considered in the danger zone ,as we have heard from many members here that  have treated even with plats falling to the 20"s
Some doctors elect to intervene with neup at  .7 ,however this is often  not a cause for many other doctors until it falls below .5 or so.

because you have been UND. since week 8 ..I wouldn't worry about the doctors recommendation on the peg,,especially in light of the fact you don't do well with the neup...

Good luck..
Will