low white count dr wants me to stop treatment

[joemc34606]

JUST TALKED TO DR ON THE PHONE, MY WHITE BLOOD COUNT NEUTRPHILS ARE AT 575. DR SAYS I NEED NUEPEGEN OR PROCRIT. MY INSURANCE PROBABLY WONT APPROVE IT UNTIL NEXT WEEK AND MY DR WANTS ME TO STOP TREATMENT FOR THE NEXT 2 DAYS. MY CONCERN IS I HAVE FAILES TWICE WITH INTERFERON AND I AM NOW ON DAILY INFERGEN. MY 4 WEEK TEST RESULTS WENT FROM 4.1M TO 58000. I AM NOW IN MY NINTH WEEK AND I WOULD HATE TO LOSE ANY OF THE PROGRESS THAT HAS BEEN.
DOES ANYONE HAVE ANY INPUT ON THE MATTER OF STOPPING FOR 2 DAYS.

[redsaleen97]

My absolute neutrophils also sunk to 400 while on Infergen @ 9mcg. They ran labs every two weeks and the count eventually rose to acceptable levels w/o stopping tx. I've been told by my doc that you can usually get away with several missed doses, but that the body clears Infergen pretty quickly, hence the daily dosing.

[IMstacie]

my ANC dropped to 400 3 wks ago,.  Got another lab test Monday, see the doc tomorrow.  He also wanted me to reduce which I haven't done, I asked for the neupo.  I'm not a relapser but I am UND, wk 28 (I think) and don't want to take any chances. I'm on interferon/riba.  

I will see tomorrow but everything I read, try not to reduce, if at all possible.

Stacie

[tracyhopkins7]

Hey - now i have something to contribute to you ha funny how the give and take goes huh?  my wbc was only at 2.2 and np made me get on neupogen but i did neupogen shot on saturday and cbc on monday showed wbc already at 4.6!!!  I said in my post that I swear the night I did the shot the sores in the corner of my mouth literally healed overnight!

The procrit takes a couple of weeks they say and since all my numbers cont. to go down i had to stay on 800 riba for now.  My ins approved procrit and neupagen at 100% which was amazing.  The doctor said that porcrit is not approved by fda for hep c treatment and because of that reason the ins does not HAVE to approve??

Good luck.  Tracy

[frijole]

http://www3.interscience.wiley.com/cgi-bin/fulltext/106597933/PDFSTART

Here is one PDF article on Neutropenia in Hepatitis C patients. If you google you will find more.  The conclusion of this article was that hep C patients treating can withstand treatment without dose modification whaen neutrophils drop as low as 500.  Infections were relatively few.

frijole

[CockSparrow]

Like Comeagain this early drop is common and could go up by themselves.
After you stop DoubleDosing, your Whites will more than likely go up slightly when you drop back to 180.

CS

[Deb_c430]

they did that to me, my Absolutes crashed the first month!  I am also on Infergen.  at that time Nov I only injected 3x a week.  Started neupogen and procrit. 15 and 1000 riba.

At that time my 4 week PCR my VL went up!  Talk about panic!  

4 days later I restarted INFERGEN   daily injections  9ml and same riba dose.  I went UND at my new 4 week.  

So yes my VL went up and yes he restarted me.     INFERGEN is a different animal than the other pegs.     I have come to the point where I consider it a predosing,   The first month.   Though I don't really think it was neccsary for him to stop me,  it all worked out ok.

Still UND I think (hope) next PCR in June. Fingers crossed, If you go look at my journal you can my lab results, first part further back, second part newer.

Deb

Deb

[nygirl7]

Neupogen (unlike Procrit) is very fast working. Procrit takes 2 - 6 weeks the Neupogen will work right away.

If at ALL possible don't let them take you OFF treatment for a minute.  it's crucial to stay on the optimum dose for the entire course of treatment without any dose reductions. See if instead the doctors office itself can call your insurance carrier directly and get the approval. Shoot even my Procrit ($6000 for a box of only 10) was approved in one day. There is no reason if they get involved it should take any longer than that to get you the neup.

Don't give up.  You might have to be a little pushy but you can do that in a nice way and just make them realize you mean business and aren't going to go away.

Once the doctor had written my script my insurance gave me trouble (again it was for the Procrit) - the pharmacy I go to tried every single variation of the Procrit script possible and finally THEY found if he wrote it for the Epogen instead (same stuff) that it went RIGHT THROUGH.

Sometimes it's a matter of instead of saying once a week saying four times a month..........stupid semantics like that believe it or not.

Contact the doctor and beg them to call and approve it and you should have it tomorrow.

GOOD LUCK!

[gauf]

Just got my cbc results and my whites are tanking too. Will get the neupogen in a week or so. I believe it takes a couple of weeks to work?  I talked NP out  of reducing the peg. She does not know that I have been double dosing so I can cut the dosage in half and still get the soc dose. I may do this but not sure yet. I did develop a bad infection on my first tox which cut treatment short so I need to be very careful here. I don't want to risk having to stop early, especially since I have just begun. It is a fine line we have to walk at times. I sure do not personally like the idea of scaling back the peg but it is a risk only you can decide to take.

---WBC 1.05 4.0-11.0 k/uL                            L
  Repeated and verified
RBC 4.03 4.5-6.0 M/uL L
Hemoglobin 12.4 13.5-17.5 g/dL                    L
Hematocrit 38.0 40-52 %                              L
MCV 94.3 80-100 fL  
MCH 30.8 27-34 pG  
MCHC 32.6 32-36 g/dL  
RDW-CV 17.6 11.7-15.0 %                           H
Platelet Count 54 150-400 k/uL                     L
MPV 9.4 7.3-11.1 fL  
Neut% 33.0 40-70 %                                    L
Abs Neut 0.35 1.8-7.7 K/uL                           L
Lymph% 36.0 22-44 %  
Abs Lymph 0.38 1.0-4.0 k/uL                         L
Mono% 14.0 0-7.0 %                                     H

[Trinity4]

I think my doctor was doing the same thing.  He actually told me he reduced my dosage because the Roche Info Sheet indicated reduction if ANC drops below 700.  He is not aggressive and I don't have the faith in him I should.  Obviously he does not stay informed of the latest statistics in treating this disease and it's really too bad because I know I'm going to have to find another doctor very soon. I'll bet if I signed a waiver relinquishing him of any responsibility if I caught an infection he wouldn't have reduced my dosage.  Yes, it's called covering their A$$.
Trinity

[comeagain]

When i asked my doc why they made me reduce when the neutrho was 600 he said that they had gone down so fast first six days that he thought they were gonna go down to under 300 if not reducing.
But i dont belive in that he was just covering his colleagues back how made the decision, because he him self was not possible to reach at that time.

[Trinity4]

I'm on peg and my ANC tanked too.  Went down to 600 and doc reduced dosage last shot.  Three days later up to 700.  I was supposed to do reduced dosage last Friday but I did the full 180.  I figure if I tank again I'll just do the Neupogen which is for WBC.  Procrit is for anemia.  I had blood work done Tuesday and go to the doc tomorrow so it should be interesting.  I am also in my 9th week of tx and want to at least get to the 12 wk mark.  Not a good thing to reduce or skip shots this early in tx.  But the flip side is you don't want to tank dangerously low even though many hepatologists are more aggresive now and don't even become concerned until ANC reaches 300-350. You certainly had an excellent viral load reading at wk 4 (much better than mine at 6 wks) and it's looking pretty good for you so maybe missing just a couple of injections won't effect your response significantly.  I really don't have much knowledge of Infergen but others here do and I'm sure somebody will chime in with more specific info.  Good luck. Trinity

[comeagain]

My neutrhils went down to 600 after 6 days and the docs made me reduce my sec pegasus shot to 135mg instead of the 180 regular. I wasn´t happy with that at all.

I´m a relapser so i dont wanna give the virus any break if possible butm they threatend me by that they would take me of tx for a week or two if the neutr continued to go down.

But they went up and tomorrow I´m gonna take shot nr 21 only had that one (my sec) shot reduced.

Yea and two weeks ago the neutrh went down to 500 but I didn´t had to do any dose
reduction they just took an extra test one week after and they went up to 700.

Normaly tis gonna be 6 weeks between blooddraws at this point of tx but since they are low they gonna check me up more often, now its two weeks between draws.

I´m in a studie for relapsers geno 2, 3 in europe, roche is providing it and roche wanted them to reduce dose when coming down to 500 but my doc and another thats in charge has decided they let them come down to 300 something dont remember exact nr could be 330 or 370 before taking action.
Theres a study that zazza on this forum told me about that study shows that HCV patients how have low neutrh in contradiction to cancer patients did not show more
responsivness to infection then them with higher lewels.

When I talked to my doc about that studie he said he know about it and that was why they dared to let them go this low.

I dont have the link but think zazza can get it if you want it. zazza post on this thread!!

We dont have rescue drugs like you have in sweden were I`m from, and even if you can get them i don´t think they allow them in the studie.

I think many doctors are to careful when it comes to neutrh. or maybe they just not up to date with information.

I don´t know the deal with infergen but hope someone else here can help you.

Don´t reduce or make pauses is my  personal nonproffesional opinion.

good luck

ca