Aa
Tips on Neupogen por favor
I was tempted to post my question in the thread pasted below since there is so much good info on it and part of what I am wondering is mentioned in it.
http://www.medhelp.org/posts/Hepatitis-C/Does-neuprogen-lower-platelets/show/1786217#post_8219349
I am wondering (in the case of cirrhotics) since your doctors did not prescribe Neupogen and opted for an antibiotic if any of you had to lower your dose of Peg? I understand I cannot apply the circumstances in your situations to mine but my ANC is only .6 and I am supposed to lower my Peg (not sure the amount but there is a notation on my labs) & start the Neupogen when it arrives. I was hoping to avoid being in this boat this soon. Especially if the only reason I would be on Neupogen is to prevent infection. From what I have read ANC can go as low as .3 and people still function.
Is it naive to think if I am just extra careful I can stave off the usual infections. I could carry hand sanitizer like lots of people and do little things like that. I doubt I could change my habits with my animals or dogs though. I mean I already have decent enough habits with them.
Riba/Hgb/Procrit
Also I may have double dosed my Riba... a bunch of times since my haemoglobin is hovering at 9.3. I think I need to keep track of my nighttime doses better and perhaps drop to 800 mg of Riba for a while. This is what the doctor said I am willing to comply with it in the short-term to see if I have compounded the problem or not. I currently administer 40,000 units of Procrit once a week...or so.
Neupogen/ANC/Peg
1. What if I maintain my Peg dose and start the Neupogen? Will my ANC continue to decrease or will it stabilize?
2. Will lowering my Peg make any kind of a difference on its own?
3. .5 does not seem that low based on many of the posts I have read.
It is not just that I don't want to be on Neupogen - it is that I am only on week 31 ande I was hoping to avoid it this soon. From what I have been seeing very few people finish treating the whole 48 weeks taking the full amount of both Peg & Riba.
____________________-
I plan to read more on Neupogen on my own however I was hoping others could share their experiences or things they have seen, heard or read. I suppose I mean the practical aspect of Neupogen rather than a bunch of studies. I know there are a bunch of old threads out there packed with good info and I plan to go through them again.
Thank you in advance :)
http://www.medhelp.org/posts/Hepatitis-C/Does-neuprogen-lower-platelets/show/1786217#post_8219349
I am wondering (in the case of cirrhotics) since your doctors did not prescribe Neupogen and opted for an antibiotic if any of you had to lower your dose of Peg? I understand I cannot apply the circumstances in your situations to mine but my ANC is only .6 and I am supposed to lower my Peg (not sure the amount but there is a notation on my labs) & start the Neupogen when it arrives. I was hoping to avoid being in this boat this soon. Especially if the only reason I would be on Neupogen is to prevent infection. From what I have read ANC can go as low as .3 and people still function.
Is it naive to think if I am just extra careful I can stave off the usual infections. I could carry hand sanitizer like lots of people and do little things like that. I doubt I could change my habits with my animals or dogs though. I mean I already have decent enough habits with them.
Riba/Hgb/Procrit
Also I may have double dosed my Riba... a bunch of times since my haemoglobin is hovering at 9.3. I think I need to keep track of my nighttime doses better and perhaps drop to 800 mg of Riba for a while. This is what the doctor said I am willing to comply with it in the short-term to see if I have compounded the problem or not. I currently administer 40,000 units of Procrit once a week...or so.
Neupogen/ANC/Peg
1. What if I maintain my Peg dose and start the Neupogen? Will my ANC continue to decrease or will it stabilize?
2. Will lowering my Peg make any kind of a difference on its own?
3. .5 does not seem that low based on many of the posts I have read.
It is not just that I don't want to be on Neupogen - it is that I am only on week 31 ande I was hoping to avoid it this soon. From what I have been seeing very few people finish treating the whole 48 weeks taking the full amount of both Peg & Riba.
____________________-
I plan to read more on Neupogen on my own however I was hoping others could share their experiences or things they have seen, heard or read. I suppose I mean the practical aspect of Neupogen rather than a bunch of studies. I know there are a bunch of old threads out there packed with good info and I plan to go through them again.
Thank you in advance :)
my anc bottomed out at 0.6 at about week 20. i was on 135mcg of pegasys which had been reduced from 180 due to rash. the hepa PA wanted me increase the peg to 180mcg at that time. the hepa PA also wanted me to have the neupogen ready in case the anc dropped below 0.5. i was feeling rather morose at the time and really did not want to increase the peg. i did develop a skin infection at about 24 week that the derm said was due to edema. i stayed on 135 and did not take the neupogen. my anc has since rebounded to 0.9. had i not been undetected at week 4 perhaps i would have been more inclined to raise the peg and start the neupogen. also one of the side effects of neupogen is rash, and i did not want to add another irritant to the body. time will tell if made the correct decision.
Thanks all. It helps to know what I am up against. Thanks Hector for posting the ANC criteria from the Peg insert as I really did not have a context. I will say the one thing that scares me the most and I am obsessive about is mouth sores/ulcers.
I did notice, when I was very careful with my health (avoiding restaurant food, washing my hands all the time, etc) that I stayed quite healthy.
Since my Tx is almost done, I loosened up with
my hygiene practices, and went to a Pot-Luck, etc.
I did catch some kind of Intestinal Bug, which
lingered for a week, with chills and cramps, etc.
I know that some of the doggy treats have been recalled, due to humans handling them, and getting sick to their stomach,(the dogs were fine, it was the brand, "Call of the Wild", but just the Treats) so make sure to wash your hands after this kind of thing
Since my Tx is almost done, I loosened up with
my hygiene practices, and went to a Pot-Luck, etc.
I did catch some kind of Intestinal Bug, which
lingered for a week, with chills and cramps, etc.
I know that some of the doggy treats have been recalled, due to humans handling them, and getting sick to their stomach,(the dogs were fine, it was the brand, "Call of the Wild", but just the Treats) so make sure to wash your hands after this kind of thing
"I am wondering (in the case of cirrhotics) since your doctors did not prescribe Neupogen and opted for an antibiotic if any of you had to lower your dose of Peg?"
No I didn't lower my peg-INF, but then again I only treated for 12 weeks. (null-responder).
For what it is worth here are the guideline on the Pegasys package insert:
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.
"Is it naive to think if I am just extra careful I can stave off the usual infections. I could carry hand sanitizer like lots of people and do little things like that. I doubt I could change my habits with my animals or dogs though. I mean I already have decent enough habits with them."
My 2 cents...
All I know about infection is related to cirrhosis. We are prone to infections of all types and they can be dangerous in our weaken state. Sine you are stage 1 I don't know how serious infections are for you. I also know that post transplant patients on immunosuppresants need to be very careful with animals especially changing litter.
Neupogen/ANC/Peg
1. What if I maintain my Peg dose and start the Neupogen? Will my ANC continue to decrease or will it stabilize?
Yes.
2. Will lowering my Peg make any kind of a difference on its own?
Yes.
3. .5 does not seem that low based on many of the posts I have read.
It is "Severe Neutropenia". But I don't have personal experience with it so I don't know the consequences of going below 0.5.
-----------------------------------------------------------------------------
http://www.neutropenianet.org/?page_id=2
"Neutrophil Levels
* Normal level: 1500 to 7000 neutrophils per mm3 of blood.
* Mild Neutropenia: when the ANC falls below a lower limit of 1500 per mm3 (1.5 x 109/l), but remains higher than 1000 per mm3 (1.0 x 109/l).
* Moderate Neutropenia: when the ANC falls between 500 per mm3 and 1000 per mm3 (0.5 x 109/l – 1.0 x 109/l).
* Severe Neutropenia: when the ANC falls below 500 per mm3 (0.5 x 109/l).
Symptoms patients experience depend on the level of Neutropenia. The lower the neutrophil count, the greater the risk of infection. This risk increases if low neutrophil counts persist for more than three days. Types of infection include otitis media; tonsillitis; sore throat; mouth ulcers; gum infection and skin abscesses. Any fever above 38.5°C/101.3°F must be taken very seriously and your nurse or physician should be informed.
Severe Neutropenia can lead to serious problems, which require prompt care since the patient could potentially develop a bacterial, fungal or mixed infection at any time. These infections can be life threatening and it is therefore important the patient be seen by a doctor as soon as possible that if the patient develops any signs or symptoms of an infection. They should then be treated with medications such as antibiotics to fight the infection."
Good luck!
Hector
No I didn't lower my peg-INF, but then again I only treated for 12 weeks. (null-responder).
For what it is worth here are the guideline on the Pegasys package insert:
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.
"Is it naive to think if I am just extra careful I can stave off the usual infections. I could carry hand sanitizer like lots of people and do little things like that. I doubt I could change my habits with my animals or dogs though. I mean I already have decent enough habits with them."
My 2 cents...
All I know about infection is related to cirrhosis. We are prone to infections of all types and they can be dangerous in our weaken state. Sine you are stage 1 I don't know how serious infections are for you. I also know that post transplant patients on immunosuppresants need to be very careful with animals especially changing litter.
Neupogen/ANC/Peg
1. What if I maintain my Peg dose and start the Neupogen? Will my ANC continue to decrease or will it stabilize?
Yes.
2. Will lowering my Peg make any kind of a difference on its own?
Yes.
3. .5 does not seem that low based on many of the posts I have read.
It is "Severe Neutropenia". But I don't have personal experience with it so I don't know the consequences of going below 0.5.
-----------------------------------------------------------------------------
http://www.neutropenianet.org/?page_id=2
"Neutrophil Levels
* Normal level: 1500 to 7000 neutrophils per mm3 of blood.
* Mild Neutropenia: when the ANC falls below a lower limit of 1500 per mm3 (1.5 x 109/l), but remains higher than 1000 per mm3 (1.0 x 109/l).
* Moderate Neutropenia: when the ANC falls between 500 per mm3 and 1000 per mm3 (0.5 x 109/l – 1.0 x 109/l).
* Severe Neutropenia: when the ANC falls below 500 per mm3 (0.5 x 109/l).
Symptoms patients experience depend on the level of Neutropenia. The lower the neutrophil count, the greater the risk of infection. This risk increases if low neutrophil counts persist for more than three days. Types of infection include otitis media; tonsillitis; sore throat; mouth ulcers; gum infection and skin abscesses. Any fever above 38.5°C/101.3°F must be taken very seriously and your nurse or physician should be informed.
Severe Neutropenia can lead to serious problems, which require prompt care since the patient could potentially develop a bacterial, fungal or mixed infection at any time. These infections can be life threatening and it is therefore important the patient be seen by a doctor as soon as possible that if the patient develops any signs or symptoms of an infection. They should then be treated with medications such as antibiotics to fight the infection."
Good luck!
Hector
I'm in week 42/48 with Victrelis and haven't had to dose reduce. Started taking Neupogen at week 12. By week 21 it was bumped to three times weekly. ANC's hanging around..3's-.7's depending on timing of lab draws. Like you and can-do I'm cirrhotic but a non-responder. My GI is the same doc I treated with 6 years ago and he didn't hesitate to dose reduce then, I wanted to avoid that this time. Had one course of antibiotics last month due to a little cough.
Like you, I'm taking Procrit. Started 60,000u/wk starting on week 16. Taking 1200mg of Riba this round versus 1000mg the first time (same weight). Hgb staying around 10. Will your doc/insurance allow you to bump the Procrit to 60.000 weekly and see what that does with your Hgb?
Like you, I'm taking Procrit. Started 60,000u/wk starting on week 16. Taking 1200mg of Riba this round versus 1000mg the first time (same weight). Hgb staying around 10. Will your doc/insurance allow you to bump the Procrit to 60.000 weekly and see what that does with your Hgb?
My understand is that a big part of the confusion about using neupogen is that it's usage for hep C is off label. The data about it is for those with non-interferon induced neupogenia.
This is why it's controversial.
And it isn't that we are susceptible to all infections. And we aren't cancer patients.
Someone mentioned using bactrim, a mild antibiotic instead, the idea being rather than playing roller coaster with your wbc, you simply use the antibiotic to prevent any infection.
Neupogen is not long lasting. This is why some doctors have patients using it twice weekly. Neup will shoot your wbc ( and anc) up, then within a few days, down they crash. It's hard on your bones. I was doing weekly cbcs, at first they had me taking neup when they were below 5.0.
Lowering the interferon dosage will indeed increase anc, it did for me.
The first time I did tx, I was cirrhotic and they still had me doing neupogen.
I agree with cando's doc, I think the stuff is way too over prescribed.
The shots themselves are more difficult. Be sure to set it out 30 minutes before using, and numb the place with ice, before doing the injection. Otherwise, these guys sting.
This is why it's controversial.
And it isn't that we are susceptible to all infections. And we aren't cancer patients.
Someone mentioned using bactrim, a mild antibiotic instead, the idea being rather than playing roller coaster with your wbc, you simply use the antibiotic to prevent any infection.
Neupogen is not long lasting. This is why some doctors have patients using it twice weekly. Neup will shoot your wbc ( and anc) up, then within a few days, down they crash. It's hard on your bones. I was doing weekly cbcs, at first they had me taking neup when they were below 5.0.
Lowering the interferon dosage will indeed increase anc, it did for me.
The first time I did tx, I was cirrhotic and they still had me doing neupogen.
I agree with cando's doc, I think the stuff is way too over prescribed.
The shots themselves are more difficult. Be sure to set it out 30 minutes before using, and numb the place with ice, before doing the injection. Otherwise, these guys sting.
Thanks Can-do (I am always tempted to say "Candy" ever since I heard NYGirl call you that name :) A .3 to .5 buffer was what I was kind of thinking. Being surrounded by small children every Saturday is a good example. I am wondering how naive it is to think I can avert certain infections by being extra careful. I still heal fairly rapidly...
I was able to treat for 48 weeks with bocep and never had a dose reduction, my ANC bounced around from .3 to .5. My hepo never was to concerned over it, thought Neupogen was over prescribed. At the time my youngest grandson was in a junior bowling league, I was worried since every Saturday I was in place full of little rugrats. His thought was more on the headaches I would get instead of catching anything... Maybe it was because he was a TP surgeon and seen much lower blood levels.
Plus I was a prior relapser and cirrhotic, so dose reducing wasn't thought of as a good ideal.
Plus I was a prior relapser and cirrhotic, so dose reducing wasn't thought of as a good ideal.
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Like you, I am a Geno 1, was und at 4 weeks, but my ANC was hammered hard much earlier. I did wonder if a slight dose reduction would have resulted in an increased ANC, but you'll only know if you try. That seems to be the question, dose reduced or neupogen?? I wouldn't think you need to do both.
Since you were und so early and on triple tx, I'd be slightly less concerned about a minor Inf reduction. It sounds like you have a good doc, so this is something to discuss face to face if you can. Plus, your doc is aware of your complete medical history, where we are not. I wouldn't worry too much about a low ANC around 0.3-0.5 as can-do stated, since mine was often around 0.3, sometimes lower. I was also cautious to try not to shake too many hands, avoid large crowds, wash hands frequently.
Following is another recent neupogen thread if you missed it:
http://www.medhelp.org/posts/Hepatitis-C/Timing-of-neuprogen/show/1786950
Good luck with your decision. Let us know.