low platelets and cbc results

[spectda]

I just got my 10 week cbc results and would love some input mainly about platelets. I assume I need less or no neupogen also.

Plates - started at 149,000, now they are 45,000. How low can they safely go? Is there anything that drug that can improve your platelet count? Can it bounce back on it's own? is it at a dangerous level currently?

ANC was at 280 4 weeks ago, 710 2 weeks ago and over 6000 2 days ago. I have taken neupogen once per week for 4 weeks.

HGB- started at 14.8 now 10.2 (I don't have to get randomized for the trial until under 10). It moving down very slowly.

Thank you!

[spectda]

Could my neupogen be causing the low platelets. after the last injection my anc went from 28o and to 710, and then from 710 to over 6000 after my fourth neup injection?

Dear doctor,

My mother is receiving chemotherapy for colon cancer, her doctor prescribed neupogen after each cycle because she had low WBC counts. She gets 3 shots in the 3 days after treatment and her counts reach about 12.000 .but after two weeks when its time for the next cycle the counts fall again and they say that they have to delay it for another week.
1) what would be the solution for this problem ? could another 2 shots of neupogen in the 2nd week help?
2)does neupogen affect platlet count because she has been having thrombocytopenia since the 8th cycle.

thank you


Answer
Hi, Neupogen acts as a granulocyte-colony-stimulating factor and is known to cause thrombocytopenia. Basically neupogen can enhance the phagocytic ('cell eating') activities of neutrophilic leukocytes (white blood cells), including activity directed at autologous platelets.  Neupogen can stimulate white blood cells to the point that they can attack the platelets in the blood, causing the low platelet count.

It may be worth seeing if she can get more, lower dose shots more often, so not increasing the amount of neupogen overall but spreading out the dose so your mother can maintain a healthy level of white blood cells.

The recommended starting dose of Neupogen is 5 mcg/kg/day‚ administered as a single daily injection by SC bolus injection, by short IV infusion (15 to 30 minutes)‚ or by continuous SC or continuous IV infusion. A CBC and platelet count should be obtained before instituting Neupogen therapy‚ and monitored twice weekly during therapy. Doses may be increased in increments of 5 mcg/kg for each chemotherapy cycle‚ according to the duration and severity of the ANC nadir.

Neupogen should be administered no earlier than 24 hours after the administration of cytotoxic chemotherapy. Neupogen should not be administered in the period 24 hours before the administration of chemotherapy. Neupogen should be administered daily for up to 2 weeks‚ until the ANC has reached 10‚000/mm3 following the expected chemotherapy-induced neutrophil nadir. The duration of Neupogen therapy needed to attenuate chemotherapy-induced neutropenia may be dependent on the myelosuppressive potential of the chemotherapy regimen employed.

I have found a paper that is very relevant to your question, as well as the information sheet for Neupogen.  I have attached the link below.

[HectorSF]

Hopefully your platelets will stabilize. As someone said, there is probably a limit to how low they will let you go. I would guess the trial protocol doesn't include transfusions either so...
I've went below 20,000 platelets from maybe 90,000 with no bleeding and I think a few have been down to low teens but that is not something you want to have happen.

Good luck.

Hectorsf

[spectda]

Thanks bill, I guess peg reduction is the only real answer as you mentioned to me earlier. Hopefully it will bounce back before it goes too low. My body doesn't seem to like the interferon. There always seems to be some new obstacle.

[EyesofBlue55]

Who was the dr that you saw in Atlanta?

[FlGuy]

I'm sure there is a continuing trial criteria for plateletes.  The trial people will let you know.

[Bill1954]

FDA safety alert for Promacta dated May 12 2010:

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm211796.htm

Promacta (eltrombopag) prescribing info:

http://www.promactacares.com/prescribe.html

--Bill

[spectda]

the team has been great. they wanted to to do something about the hgb at 10.4 but were willing to wait to intervene because the parameter is 10 for the trial. Glad they waited since it only dropped .2

I think they will allow the platelets to go to 25,000. Bill told me there was a drug that they were testing for increasing platelets a year or two ago, but there were some problems with the drug and it most likely is not being used.

Thanks everyone, no knife throwing or carrying scissors around.

[wtgb]

Sounds like some positive news for you re ANC this week.  I am not real familiar how the platelets are managed.  I have found that open communication with your trial team while being your own best advocate helps the team and you decide based on your own personal results how much wiggle room there is with your numbers.  Hope you get more good week 10 results soon!!

[Trinity4]

Not a whole lot you can do for low platelets.  Yes, they do fluctuate from week to week.
They are low, but in my case my hepa in Atlanta didn't bat an eye when mine went to 50,000.  If I recall, he said he didn't become concerned until he sees 20,000 but advised me not to enter any knife throwing contests.   He was also a very aggressive doctor.

I'm sure your trial will have a cut off but with any luck they'll rise soon and they won't dose reduce.

Trinity  

[jt57]

wbc and hgb  sounds ok to me, from my tx experience.  but platelets can be a problem.  I have the same issue.  Yes, they can bounce around.  and it all depends on the dr as to how low they will let you go.  the interferon influences the platelets.  my dr would let 45 go.  but some wont.  I am on wk 22.  I have been in the 50's for the last 10 wks or so.  Just be careful.  no knives, falling, etc.  

Good luck,

Jean