Low Neutrophils

[Diana66]

Since I started tx with a base of 1.64 I have been flaoting around the 0.56-0.7-0.88-1.05 for the last 14 weeks

Today all of a sudden I bottomed to 0.3. This is on an already reduced Interferon dose of 135. I am waiting to hear from the doctor now of what the plan is but would this sudden drop be just from the Interferon or is it possible to have other reason as well

2 weeks after the Incivek: Hemoglobin at 10.1, Platelets at 58 so only the Neutrophils are the problem

Any ideas, suggestions?

[Diana66]

Hi Advocate

the initial dose reduction on week 8 was the right thing to do and was due to low platelets. Not much to do about that unfortunately. At least I was still in the game to go through Incivek. I am surprised that I bottomed now 2 weeks after I finished it

If tx is not successful, it will probably be because of the CT allele and not due to the dose reduction. It was always going to be a challenge because of the cancer situation and somehow I surprised the doctors doing so well for so long. Not to mention no rash on Incivek

Fingers crossed and will see what results today will be

[Diana66]

Hi Bean

i am on the costant care of 3 or 4 specialists: hepatologist, hematologist/oncologist, renal specialist, general medicine specialist, immunologist, orbital specialist :)

Between all of them I hope I am getting the best I can
We will see in a few hours what the blood counts are coming back at. Was not much to do over the weekend. Tx will not be interrupted but a dose was only delayed and will certainly be reduced, so when I will go back, it will be on 90

Since I am on public system, all these doctors are receiving updates on the same day. Hematologist is aware and is following up my case.

Hepatologist is the one deciding right now and he will be the one prescribing neupogen if considered so.

I did start with a lower neutrophils number at only 1.64 and we always knew that it might be a possibility that it will bottom.

I am not worried about an infection, there is a very low probability for that
I know the stats regarding the interferon dose reduction, not looking great if reduction is under 80% but in reality those studies are for interferon and Riba only. I have not seen yet one on the triple tx

My doctor on the other hand has more exposure to this as he is running some of the majors trials in the world

We will see what his update is today

[Diana66]

There is a reason I treat with a doctor.

If he considers that I have to delay the dose, I am sure this is the right decision as painful as it might be.
Just had my new tests so in a few hours I will know if I can do my shot today. That will be only 4 days delay

Yes, ANC will go up and down and it did, but 0.3 is way to low not to do something about it.

I went down to 36000 on platelets only with minimal dose reduction so my doctor is certainly pushing the limits. Will see what happens today, fingers crossed :)

[frijole]

Diana, from your profile...

"Diagnosed at the end of March 2012 with Marginal Zone Lymphoma Stage 4 with 28% Bone Marrow Involvement"

Diana, are you under the care of a hemotolgoist to monitor your blood, notwithstanding your hepatitis C treatment?  I admit to being too lazy or busy or out of the loop to research right now, but this seems to me to be comorbitity of the highest.  If you have bone marrow issues, is this not increasing the chance that your bone marrow cannot make more white blood cells?  That is what neupogen does - it helps the bone marrow make more blood cells, and at .3 ANC it appears you need that.

I (personally) think that if you are to be successful at this treatment for hepatitis C, you need to stay on interferon.  Are your treatment doctors aware of and capable of making decisions that may also relate to the lymphoma? Did your lymphoma doctor sign off on treatment for hep C?  This is a complicated case. You say it is out of your hands, but I suggest going to the doctor who is treating your lymphoma.

I don't think any of us here can help you.  We can discuss dose reductions vs neupogen, and we can discuss the side effects of both, but I think this goes beyond whether or not you are going to get an infectino.

I wish you success with hard decisions ahead.

bean

[nygirl7]

No dose reduction. Missed dose? Your ANC will go up and down. Please listen to the people above. My doc scoffed at my lowering ANC ... I am svr seven years. That is your goal.

Hang in there. Take your meds. .5 is fine. I was on 69 weeks of 80k Procrit I never dose reduced.

[Advocate1955]

I'm really concerned about your dose reduction and now missed dose as well.  I know that you're UND, but part of the problem with has to do with what happens when Interferon is decreased or stopped.
Wishing you the best with your labs on Monday and hoping that your ANC is coming back up so you can continue or they will prescribe Neup so you can continue.
Advocate1955