white blood count

[net1962]

My wbc went from 4.2 to 1.6 in 3 weeks. I am on 180mg of pegasys and 800mg of riba. pills. He has decreased the shot to 135 mg. Is this normal?

[frijole]

Excellent information - do you regularly read Clinical Care Options?  So much good stuff there -- I recommend getting on their email list (tells you when a new program is posted) to everyone and spending the time to go thru their programs.

http://www.clinicaloptions.com/hepatitis/treatment%20updates/hcv%20core%20curriculum.aspx

These are audio programs or slide shows or text information to be used by medical professionals for continuing education hours.  Theyare free and anyone can register.  There is a wealth of information on hepatitis C and treatment information.

Are you still treating?  I read your profile -- OW - 341,000 at week 12.  So sorry.  Like your woodstock pic!

frijole

[dorsey15]

To: Hector
Thanks for ALL your great information today!!  very enlightning for me and I hope a lot of other geno's 1 A's treating or thinking of treating.....
I will continue to treat for the 48 weeks just to be sure of SVR for a lifetime...not that it is a guarantee anyway; but just to ease my mind that I followed the original guidelines...even though I would LOVE to stop at 24 weeks!! believe ME!--these sides suck....
Your information made me feel a lot better about keeping going though!
Thanks for taking the time and effort ! I REALLY appreciate it!
God bless...
Dorsey

[HectorSF]

I would just add to frijole's excellent comments and advice, that reducing interferon and ribavirin early in treatment can lower your chances of SVR. So please get the helper drugs you need first, before reducing your treatment meds.

How it effects the chances SVR depends to a large degree upon when the virus becomes undetectable. Basically you don't want to reduce the dosage until after the virus is undetecable and then only in a step by step fashion.

For example Dorsey will have no impact on SVR from her riba reductions because it was after the virus became undetectable and persons with a RVR have about a 90% chance of SVR anyway.
Mitchell L. Shiffman, MD
"...the likelihood of SVR patients with genotype 1 infection who achieve an RVR does not appear to be affected by shortening the duration or reducing the dose of ribavirin. In one trial, patients with genotype 1 who achieved undetectable HCV RNA were randomized to stop or continue ribavirin at treatment Week 24. Patients with RVR had an SVR rate of approximately 90% whether they continued or stopped ribavirin.[14] A retrospective analysis in patients with genotype 1 demonstrated that reducing the dose of ribavirin in patients with RVR also did not impact the rate of SVR.[15]"
14. Bronowicki JP, Ouzan D, Asselah T, et al. Effect of ribavirin in genotype 1 patients with hepatitis C responding to pegylated interferon alfa 2a plus ribavirin. Gastroenterology. 2006;131:1040 1048.
15. Reddy KR, Shiffman ML, Morgan TR, et al. Impact of ribavirin dose reductions in hepatitis C virus genotype 1 patients completing peginterferon alfa 2a/ribavirin treatment. Clin Gastroenterol Hepatol. 2007;5:124 129.

So in general...

Mitchell L. Shiffman, MD
"Several studies have now demonstrated that mild reductions in the doses of either peginterferon alfa and/or ribavirin will not adversely affect the chance of achieving SVR, especially if this strategy is employed after the patient achieves undetectable HCV RNA.[15,24] By contrast, interrupting treatment for more than 7 days because of adverse events leads to breakthrough and relapse.[24] Therefore, it is the recommendation of this author to reduce ribavirin stepwise by 200 mg every 2-4 weeks until adverse events either resolve or are tolerable. Peginterferon alfa-2a can be reduced from 180 to 135 µg/week and peginterferon alfa-2b from 1.5 to 1.0 µg/kg/week. Neither peginterferon alfa nor ribavirin dosing should be interrupted unless the adverse event is particularly severe and there is a concern for patient safety. Whenever the doses of peginterferon alfa and ribavirin are modified or temporarily interrupted, HCV RNA testing should be performed again to ensure that breakthrough has not occurred."

15. Reddy KR, Shiffman ML, Morgan TR, et al. Impact of ribavirin dose reductions in hepatitis C virus genotype 1 patients completing peginterferon alfa 2a/ribavirin treatment. Clin Gastroenterol Hepatol. 2007;5:124 129.
24. Shiffman ML, Salvatore J, Hubbard S, et al. Treatment of chronic hepatitis C virus genotype 1 with peginterferon, ribavirin, and epoetin alpha. Hepatology. 2007;46:371-379.

Cheers!
Hector

[rita863]

my last white count was 1.8, i am week 27, 800 mg of riba  peg has never been lowered.  no procroti or neupogen.

[dorsey15]

I'm getting ready to start my 25th wk this week and I have been on Neupogen shots since my 3rd week.  I'm geno 1 A-- pega 180 & Riba 800.. had to drop Riba from 1000 @ wk 3 to 800 and it has stayed @ 800 since (weight based though and should have been @ 800 to start)  I cleared at wk 4 and have stayed cleared since)
I started Neupogen every other week @ wk 16... I usally drop my neutrophills down to 750--1000 doing every wk... so doc thinks that's ok-- and it's OKAY w/me because it's just 1 LESS SHOT for me!! I don't like the sides... a little bone pain, headache and more sweats on the weekend I do INF shot. but at least I haven't had to reduce INF level..
Check with your doc to see if this would work for you.  Just a suggestion...
Good luck in your treatment and clearing the dragon..
Dorsey

[frijole]

Sounds like both of you need to check with your doctor about what we fondly call rescue drugs.  Neupogen boosts white blood cell production and Procrit boosts red blood cell production.

Net - throughout my 56 weeks of treatment my WBC was always in the 1s and I rarely got sick.  The lab that most of the doctors watch for is the absolute neutrophils.  Neutrophils are a type of white blood cell necessary to fight infection.  When it is low, you are open to a multitude of infections,.  However, low is a lot lower than WBC of 1.6.  What is your ANC (absolute neutrophils) - also could be shown as #NE or ANC on your CBC (I will put a plug in now to get copies of ALL of your records.  Every blood test, genotyping test, PCR, CBC, biopsy report , etc.  Doctors tend to blanket everything with "you are doing fine" or "we need to watch that" when, if you have your own records, you can see the progression and know yourself what is happening).  Optimal ANC is 1.5 (1500) but most doctors will reduce INF or rx a blood booster if it gets under .75 (750).  In reality, ANC can get much lower - as low as 400 - in a hep C patient and not cause problems.  OF course, if you are cirrhotic, they won't let your ANC get that low!

boo  - can you talk to your doctor about rescue drugs?  The best thing my GI did for me is make an appointment with a hemotologist (blood specialist) at the beginning of my treatment.  She monitored my blood all throughout my tx .  I encourage you to find out about it and read some threads on this forum about these rescue drugs vs dose reductions.

frijole

[booocooo]

Hi!

I've been on a medication rollercoaster the last 8 weeks (I'm in my 12th week of Tx).  I've had my Riba bumped up and down b/t 1,000 and 800, as well as my Peg lowered to 135 twice.  My whites are at 1.3 and I still did 180 this last week, however, they are taking blood tomorrow to find out where I'm at.  If it's still going down, they will lower me to 135 for the next two weeks.  So, to answer your question, YES - to me it's normal :)  It's been the story of my Tx so far....up and down, up and down!

Just curious, how's your hemoglobin?  Has that dropped too?  Hang in there :)