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?

[flcyclist]

Since I was a Geno 1a and only on Inf/Riba (48 wks), I was very reluctant to do any dose reductions.  My gastro doc agreed, so neupogen allowed me to continue from wk 8 until eot with any dose reductions.  I agree with the others, that this would concern me, especially being cirrhotic.  You want to give yourself the best chance possible.  

However, based on the dose modifications guidelines for Pegasys, it states that for an ANC < 750 to reduce to 135 mcg and for ANC < 500 to discontinue treatment until ANC values return to more than 1000 cells/mm
and Reinstitute at 90 mcg and monitor ANC.   I'm fortunate that my doctor didn't following this prescribing information and prescribed neupogen instead, otherwise who knows what the outcome would have been.  There are different theories on which is the best approach.  I wish you the best outcome.  

[jules2551]

I have to speak up and say i dont agree with sny kind of reductions. That is your choice. A friend of mine is tracking dose reductions and 17 have relapsed. Whether it be Riba or Inf doesnt matter. The main point is go as long as you can without reductions. That is the whole point eith tx. Dont reduce anymore and get Nuep

[can-do-man]

"The newer theory is that even for people with cirrhosis (which I do not have) is ok to reduce Interferon to 90 once they are UND"

I take it you have not seen the video about the current CUPIC study? It's becoming quite clear even dose reducing the Riba is not a good ideal for cirrhotics

[Advocate1955]

Isn't the ribs NOT supposed to be taken alone? Diana, I would really try not to reduce and try to insist on Neup. I agree w everyone, a couple of days to rebuild, but you will probably remain on weekly CBCs.

[Diana66]

Interferon is reduced to 135 since week 8

The newer theory is that even for people with cirrhosis (which I do not have) is ok to reduce Interferon to 90 once they are UND

Usually I am due for the shot on Thu night. Specialist did ot recommend neupogen, even though they do have stuff available
I have been told to not do the shot and repeat test on Mon. If all good, do it ( which will make it 4 days late basically)

If neutrophils still low on Mon, then we will look to options. This would have been week 19.
Nobody will give me neupogen in the weekend so I do not have much choice right now

Specialist is really good and if he made the statement that a skip or a delay right now after Telaprevir and UND, he must base this statement on something

Well should see on Mon, midday what results I have on blood counts. Not that I really want to change my shot to Mon, but what can I do?

[jules2551]

Haven't you already reduced your INF to 135? I would carefully reconsider reducing anymore and especially skipping any doses.