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  • Neutropenia

    So I'm in week 3 if round 1 of 4 and today's labs turned out not so good for white cells. Before starting 2 weeks ago i was at 11.5 last week i was at 8.7 this week though I only had 1.7. and absolutely count of neutrophils was only around 200.

    So basically, I'm curious about what may happen next week. I know that this week they should go back up some but I doubt they would go up a lot and considering how much they fell from round 1 hate too see round 2. Anyway while it's still a week away I would appreciate any advice on this issue. Especially considering next week is the start of a new round and with numbers low like that of they don't go up a lot I'm worried they might say to postpone, which of course causes it's own issues as would give the cancer more time to adapt, and since i would only be in round 2 of 4 I don't feel that would be a good thing.

    For a bit of knowledge originally staged 3b with a lemon sized tumor in aortic nodes as well as several smaller tumors spread throughout both lungs. So really would be concerned about delays with all that. Hence would love some input especially if you have dealt with a similar situation with very low counts.

  • #2
    The same thing happened to me at the same time in my treatment. I was given a shot of Nuepogen when they first noticed the counts were low. Then I was given a shot of Nuelasta during cycles 2, 3, and 4. These had a dramatic effect and my counts were ok for the rest of treatment. Your oncologist should recommend this or something similar. If he/she doesn't, you should mention it. Note that these drugs are crazy expensive so you may have some insurance issues, but they are highly effective.

    You probably already know this, but while your counts are low, be very careful about getting sick. Try to stay away from crowds. Wear a mask if you are in a crowd, especially the hospital or doctor office. Wash hands etc. One other thing, these drugs cause bone pain. And it sucks as much as it sounds. One trick to avoid this is to take Claritin (not Claritin D). Don't know why, but this helps. I learned the hard way until a nurse suggested this during cycle 2.

    .

    Comment


    • #3
      Yea they have me information on what to do not to do etc but that was all. I'm out in the country so avoiding crowds is by far the easiest thing to do. I'll have to see what he says. I just know I really don't want them to delay things as that can cause is own slew of issues. I also have made sure to keep watch on temps. While a little elevated staying in the 97s. Think tonight was highest its been at 98.3. Yea I run cold whole 96.8 is normal

      Comment


      • #4
        I just had this issue today and was wondering how things turned out for you? I went in for my third Bleomycin in cycle 1 (so week 3), and they said that my white blood cell count was too low for treatment, so they told me I couldn't have chemo today and pushed things back a week.

        They first told me my white blood cell count was low during my first follow up last Friday, but they said it wasn't low enough for the shot (assuming this is the Neupogen from the post above?), though apparently it's low enough to delay my treatment. Any thoughts or experience on this would be super helpful. Thanks!
        11/15/2016 - Ultrasound detects mass in left testicle
        11/23/2016 - Left I/O
        12/8/2016 - CT Scan indicates 2 enlarged lymph nodes, staged IIB
        12/21/2016 - Meet with medical oncologist, scheduled 3xBEP
        1/9/2017 - Began 3xBEP
        3/20/3017 - Finished 3xBEP (phew)

        Comment


        • #5
          They should not have denied you chemo. At this point the counts will recovering on their own. Also Bleomycin has no affects on those counts. Maybe they could have given you neupogen or neulasta but denying chemo at this point should not have happened...unless you have neutropenic fever.

          You should get in contact with Dr. Einhorn as I am sure he would have said the same thing regarding denying chemo. I know Dr. Nichols has stated that exact same thing.

          Read the last section (a few important final tips) of this link that says just this:
          http://tcrc.acor.org/chemo.html

          - Matt
          Last edited by JeskiM69; 01-23-17, 08:34 PM.
          March 4th 2014: [AFP = 2.5; bHCG = 6; LDH = 618]
          March 13th: Left IO 100% Classic Seminoma
          6.3 x 5.1 x 3.8 cm, no invasion of anything
          LDH never fully normalized
          Stage: IS
          Watchful Waiting
          May 1st: promoted to Stage IIB with two PET active tumors in the para-aortic lymph nodes 2.5 & 2.4 cm
          May 12th: started 3xBEP
          Neupogen during Cycle 2 and 3
          July 8th: Last Bleo shot of Cycle 3 -- chemo completed !
          August 4th: Post Chemo CT/PET scan
          September 4th: Port removed
          January 8th 2018: 3.5 YEARS ALL CLEAR !

          Comment


          • #6
            Learn so much reading posts! Joey- been wondering about you, I read your your blog. Hope you get it figured out.
            Original poser- update us please.
            Son Grant
            dx 12/21/16 at age 17

            BEP x3
            Post Chemo CT Scan on 3/28/17 still showed a few nodes over 2 cm
            2nd Post Chemo CT Scan on 4/27/17 showed all nodes still over 2cm
            Post Chemo RPLND 5/8/17: Periaortic Teratoma, Intraaorticaval Teratoma, and Paracaval Teratoma found.

            Comment


            • #7
              Hi Joejoey,

              I echo what JeskiM69 said. If it was me, I would get my lab results and then see if my physician would contact D.r Einhorn's team at Indiana University for some advice. Their contact information is on our friends at the TRCR site at: http://tcrc.acor.org/experts.html Perhaps they could give you the bleomycin tomorrow as well as neupogen or nulasta to prevent the cycle starting next week from being delayed. Bleomycin should not really have an effect on the white count so I am not aware of a low count being a reason to hold it.

              Mike
              Oct. 2005 felt lump but waited over 7 months.
              06.15.06 "You have Cancer"
              06.26.06 Left I/O
              06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
              06.30.06 It's Official - Stage I Seminoma
              Surveillance...
              Founded the Testicular Cancer Society
              6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

              Comment


              • #8
                Mine count went from 4.3 last Monday to 0 yesterday (which was the last bleo treatment for cycle 1). Is it normal for them to not administer one of those N drugs when you bottom out? They told me the same thing, avoid public and sick people and just to call them if I get a fever.
                Thanks,
                Geoff

                Comment


                • #9
                  Geoff,

                  It seems to vary by individual oncologists as when/if and which N drug one gets.

                  For example my onco. has a tendency to more vigilant and pre-emptive about some stuff compared to another onco that I had for a short while. My ANC hit 0 on all three cycles but it was only on cycles 1 & 2 that I got the Neupogen....I never asked why...I think I will at my next checkup...provided I can remember to.

                  - Matt
                  Last edited by JeskiM69; 01-24-17, 09:35 PM.
                  March 4th 2014: [AFP = 2.5; bHCG = 6; LDH = 618]
                  March 13th: Left IO 100% Classic Seminoma
                  6.3 x 5.1 x 3.8 cm, no invasion of anything
                  LDH never fully normalized
                  Stage: IS
                  Watchful Waiting
                  May 1st: promoted to Stage IIB with two PET active tumors in the para-aortic lymph nodes 2.5 & 2.4 cm
                  May 12th: started 3xBEP
                  Neupogen during Cycle 2 and 3
                  July 8th: Last Bleo shot of Cycle 3 -- chemo completed !
                  August 4th: Post Chemo CT/PET scan
                  September 4th: Port removed
                  January 8th 2018: 3.5 YEARS ALL CLEAR !

                  Comment


                  • #10
                    Wow--thank you all SO much for the helpful information. You're right, JeskiM69, the answer to my question was right there. I am reaching out to my oncologist now to see if we can keep me on the original treatment schedule. Also interesting was the information about the Cisplatin dosage--I had met with the nurse practitioner recently and she informed me that they might consider lowering my Cisplatin dosage due to the tinnitus I've been experiencing, but she seemed to indicate it would not have any impact...interesting that it seems the data says otherwise.
                    11/15/2016 - Ultrasound detects mass in left testicle
                    11/23/2016 - Left I/O
                    12/8/2016 - CT Scan indicates 2 enlarged lymph nodes, staged IIB
                    12/21/2016 - Meet with medical oncologist, scheduled 3xBEP
                    1/9/2017 - Began 3xBEP
                    3/20/3017 - Finished 3xBEP (phew)

                    Comment


                    • #11
                      You cannot always trust the Onco nurses. They are not nearly as familiar with the chemo regimens as the experts or even your treating oncologist. It's best that you arm yourself with info like this so that you can stay on top of them.

                      I got into a heated argument on my final day of chemo because the nurse wanted to delay the Bleo another week. I argued with her all the way into my onc's office and ultimately I won, got my last dose of chemo, and got out of there....but it was not fun to have to get into an argument like that...it was a big scene and it was the first time during chemo that I got truly mad about anything....I felt bad, but I knew I was right.

                      - Matt
                      March 4th 2014: [AFP = 2.5; bHCG = 6; LDH = 618]
                      March 13th: Left IO 100% Classic Seminoma
                      6.3 x 5.1 x 3.8 cm, no invasion of anything
                      LDH never fully normalized
                      Stage: IS
                      Watchful Waiting
                      May 1st: promoted to Stage IIB with two PET active tumors in the para-aortic lymph nodes 2.5 & 2.4 cm
                      May 12th: started 3xBEP
                      Neupogen during Cycle 2 and 3
                      July 8th: Last Bleo shot of Cycle 3 -- chemo completed !
                      August 4th: Post Chemo CT/PET scan
                      September 4th: Port removed
                      January 8th 2018: 3.5 YEARS ALL CLEAR !

                      Comment


                      • #12
                        I continue to use Neupogen on a weekly basis since my stem cell transplants. So, I cannot think of a reason why you cannot and should not be on drugs to increase your white cells. And, a word of advice based on my 5 years of fighting with cancer is that you should trust only yourself. Consider your doctors and nurses to be your advisers / consultants and yourself as the boss / decision maker. There needs to be a very good reason (read something that will kill you very quickly) to lower your dosage or delay treatment, etc. The only time my dose was reduced was when I lost my kidneys. Tinnitus should be super severe to reduce dosage, and remember it gets better once you are done with the treatment.
                        Jan '11 - Stage IIIc, Mets in lungs and liver, abdo 7*7, pulmonary embolism
                        Right I/O AFP 13,000, bHCG 110, Scrotal Hematoma, IVC Filter
                        4*BEP AFP 20 end of 4*BEP
                        May '11 - RPLND @ Indiana U - inferior vena cava dissected, necrosis, AFP<5
                        Surveillance (blood & X rays) and all clear for 24 months
                        April '13 - AFP 26 , went up to 46 in a week, Negative CT Scan, Ultrasound and head MRI
                        4xTIP - almost normal AFP, but started rising again
                        2 x HDC with Autologous Stem Cell Transplant - AFP almost normal but started rising again
                        Lost kidneys, damaged liver, chirhosis, ascites 2 liters per day, dialysis 3 times per week, disabled
                        2 Lung Wedge Resections -

                        Comment


                        • #13
                          Originally posted by joejoey View Post
                          Wow--thank you all SO much for the helpful information. You're right, JeskiM69, the answer to my question was right there. I am reaching out to my oncologist now to see if we can keep me on the original treatment schedule. Also interesting was the information about the Cisplatin dosage--I had met with the nurse practitioner recently and she informed me that they might consider lowering my Cisplatin dosage due to the tinnitus I've been experiencing, but she seemed to indicate it would not have any impact...interesting that it seems the data says otherwise.
                          I've also had this suggested due to my tinnitus and hand sensitvity. I'm not sure what lowering the dosage for my last round of BEPX3 will do, but I'm going to insist they slow down the infusion a bit to help the side effects, which might be useful for you to?
                          24 year old diagnosed 6/11/16
                          Pre/o markers 9/11/16 - HCG 15, AFP 210, LDH 539
                          Pre/o CT Clear
                          Non-seminoma (80% embryonal carcinoma, 10% yolk sac tumour, 5% chorea carcinoma, 5% seminoma)
                          Post-op markers - 14/12/16 - HCG 35, AFP 1050, LDH 430
                          Post-op CT with one enlarged lymph node - 1.5x1cm
                          Borderline stage 2B/3B
                          BEPx3 started 15/12/16 (Borderline BEPx4 - Advise of Dr. E to only do 3 rounds)
                          CT and markers clear - in remission - 28/2/16

                          Comment


                          • #14
                            Ultimately it's best to get the full dosage.

                            One thing to inquire about is if they can slow the rate at which they run the drip. If they run the drip slower it can reduce some of the short term side effects.

                            - Matt
                            March 4th 2014: [AFP = 2.5; bHCG = 6; LDH = 618]
                            March 13th: Left IO 100% Classic Seminoma
                            6.3 x 5.1 x 3.8 cm, no invasion of anything
                            LDH never fully normalized
                            Stage: IS
                            Watchful Waiting
                            May 1st: promoted to Stage IIB with two PET active tumors in the para-aortic lymph nodes 2.5 & 2.4 cm
                            May 12th: started 3xBEP
                            Neupogen during Cycle 2 and 3
                            July 8th: Last Bleo shot of Cycle 3 -- chemo completed !
                            August 4th: Post Chemo CT/PET scan
                            September 4th: Port removed
                            January 8th 2018: 3.5 YEARS ALL CLEAR !

                            Comment


                            • #15
                              Just wanted to thank you all again for this. My oncologist called me today and said that I was right...He said it was a miscommunication with the nurses and that he thought it was the start of my second cycle. Not entirely thrilled that this mistake was made, but I'm SO thankful for this forum for helping me catch it. I'm going in this morning to get the third Bleo that I should have had Monday.

                              You all are the best. Thank you.
                              11/15/2016 - Ultrasound detects mass in left testicle
                              11/23/2016 - Left I/O
                              12/8/2016 - CT Scan indicates 2 enlarged lymph nodes, staged IIB
                              12/21/2016 - Meet with medical oncologist, scheduled 3xBEP
                              1/9/2017 - Began 3xBEP
                              3/20/3017 - Finished 3xBEP (phew)

                              Comment

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