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  • Low WBC

    This is day 16 of round 1 for my son. He had his Bleo shot. I drove him to his appointment, but he asked me not to come up. I was lucky he allowed me to drive him and that he agreed to spend the night at our house so I didn't want to push it. The downside of that is I didn't get to ask questions (which is probably why he didn't want me to come up in the first place!) So once again, I'm asking you. He had two blood tests last week (which I found unusual, but whatever) and he was told today that his wbc was low and he would have to give himself shots next week. So I'm wondering, first of all, why he has to wait until next week (which is when he starts Round 2) Second of all, not that it matters, but why is he giving himself the shot if he's going to be there anyway for his 5-day treatment? Third of all, should I assume he's going to give himself a Neulesta shot or are there other shots to elevate wbc? If so, does he just get the shot once or is it a series? Thanks for any light you can shed on this for me.
    a mom

    Son, age 25
    2/28/12 Right I/O
    Stage 1 nonseminoma
    Embryonal carcinoma - 60%
    yolk sac tumor - 30%
    focal seminoma - 10%
    LVI
    CT scan clear
    AFP - 22
    4/9/12 BEP x 3

  • #2
    Neupogen is given daily, usually done by the patient themselves since it is subcutaneous, but I suppose he could ask a nurse to give it, but he continues on it for a few days after chemo as well so he will need to know how to administer it anyways. Neulasta is given only once per cycle the day after his last dose of chemo (usually Sat.) as an intermuscular (IM) shot.

    Based on what you described it sounds like he will be on Neupogen (cheaper option of the two)
    sigpic
    Diagnosed 4/17/08
    Right orchiectomy 4/18/08
    Pure choriocarcinoma; HCG 715,000; lungs, lymphnodes, liver, and random other places
    4X VIP chemo at IU with Dr. Einhorn 4/25/08-7/4/08
    HCG down to 7.2 10/28/08
    HCG back up to 198 12/29/08
    1 X PVB 1/2/09-1/6/09
    2 X HDC w/ stem cell rescue 2/4/09-3/14/09
    Follow-up with Dr. Einhorn 4/22/09
    HCG 1.2
    3 rounds, 21 days, twice daily, VP-16 50mg 4/24/09-7/10/09

    http://www.caringbridge.org/visit/johncovell

    Comment


    • #3
      Jay was given shots at treatment during Bleo and further chemo's. You can learn to give him shots if he will allow it. As far as WBC counts going down. Thats automatic, chemo kills the good cells along with the bad cells. Our doctor put him on Levaquin, the first time his WBC dipped, that stuff is fantastic and then he went on another antibiotic that he took daily throughout treatment.
      Diagnosed Mixed Germ Cell tumor Carcinoma and classic seminoma StageIIC 6*8cmbulky June 26-08
      Left I/O June 26-08 4*BEP July-08-Sept-08
      Mets to Abdomin/chest,
      Stage III, , 6*8 cm Jul 08
      Markers normalized Nov08, residual tumor 3*2cm in abd. 13mm in chest. Spinal Stenosis,Neuropathy RPLND feb 09
      Found all three: Cancer, teratoma and scar tissue
      10/09 B-HCG up to 39.90, recurrent TC, 2*VIP 12/09, TI started 05/11/2010, stem cell infusion 5/18/2010 day of rebirth
      08/10 all clear

      Comment


      • #4
        Thanks for your replies. But I'm just wondering, if his wbc is low now, why are they waiting almost a week to give him a shot?
        a mom

        Son, age 25
        2/28/12 Right I/O
        Stage 1 nonseminoma
        Embryonal carcinoma - 60%
        yolk sac tumor - 30%
        focal seminoma - 10%
        LVI
        CT scan clear
        AFP - 22
        4/9/12 BEP x 3

        Comment


        • #5
          I think they want to see how well his counts recover on their own. Some docs do that, I never understand why. IU starts WBC booster shots regardless. I think they are trying to put him on the typical schedule, i.e. start when chemo starts. then stop a few days after chemo. Neupogen starts to work immediately, where as neulasta takes 7-11 days before the rise starts to happen. Antibiotics are only needs if he starts to run a fever. low grade fever is expected, but when he is neutropenic (low WBC) you should be checking his temperature about ever 2-3 hours.
          sigpic
          Diagnosed 4/17/08
          Right orchiectomy 4/18/08
          Pure choriocarcinoma; HCG 715,000; lungs, lymphnodes, liver, and random other places
          4X VIP chemo at IU with Dr. Einhorn 4/25/08-7/4/08
          HCG down to 7.2 10/28/08
          HCG back up to 198 12/29/08
          1 X PVB 1/2/09-1/6/09
          2 X HDC w/ stem cell rescue 2/4/09-3/14/09
          Follow-up with Dr. Einhorn 4/22/09
          HCG 1.2
          3 rounds, 21 days, twice daily, VP-16 50mg 4/24/09-7/10/09

          http://www.caringbridge.org/visit/johncovell

          Comment


          • #6
            Originally posted by TC Destroyer View Post
            I think they want to see how well his counts recover on their own. Some docs do that, I never understand why. IU starts WBC booster shots regardless. I think they are trying to put him on the typical schedule, i.e. start when chemo starts. then stop a few days after chemo.
            I don't understand that either, as Duke gave Neulasta as a precaution each cycle. Maybe they want the body to put up a fight on its own to see what it can do?
            Heidi

            Husband - age 51
            10/20/10 - Primary mediastinal seminoma - 10 x 9.3 cm; -HCG = 33 (<2.6); AFP = 3.5 (<9); LDH = 274 (100-200 )
            11/1/10 4X BEP
            12/7/10 End Cycle 2 - -HCG = 2; AFP = 4.6; LDH = 139 ; 4XBEP changed to 3 as tumor now 2.1 x 3.7 cm
            2/15/11 - Post-chemo PET ; residual 8 mm x 2 cm
            6/29/11 - Lung nodules stable or smaller, chest mass continues to shrink & markers all normal
            Surveillance since 6/11

            Comment


            • #7
              I'm guessing some docs would rather not give treatment until there is indication that it is actually needed. It's not good to get the white count too high, although that seems pretty unlikely when getting chemo.

              As far as the OP's son, I'm guessing they want to start the shots when his second long week starts?

              Dave
              Jan, 1975: Right I/O, followed by RPLND
              Dec, 2009: Left I/O, followed by 3xBEP

              Comment


              • #8
                Today was day 1of cycle 2 for my son. He prefers his brother and gf go with him than me so i dont get to ask the questions (probably why lol)...today he said the nurses did blood test and said his wbc is low; called the dr to get approval to continue chemo. I asked if he was given or told about injections to increase wbc and he said no. I guess his dr is waiting to see how his body is responding..idk. if iu begins shots right away maybe he should mention this to dr. And now that his wbc low i guess we should closely.monitor temp.

                Eli s way of dealing with this is just to show up and go through the treatment. He doesnt ask questions..just waits for dr to give info .(although he understands and is very vocal that treatment cont no matter what).

                Today i asked him about afp and hcg markers and he hasnt been told. I hoping the dr would inform him if the numbers are not dropping as they should so ee could re evaluate treatment??

                In the meantime my husband has a bacterial tonsillitis and is isolated away from eli at my mom s house. On a good note eli found day 1 round 2 much easier than day 1 round 1.

                Lori
                Eli s mom
                6/15/12 left i/o
                50%yolk sac 35%embryonal 15%seminoma
                No lvi markers back to normal
                stage Ia surveillance
                8/12 chest xray markers normal
                9/12 ct enlarged retroperitoneal lymph nodes 3cm
                10/12 markers elevated
                Stage IIa
                10/15/12 bepx3
                Lori
                Eli s mom
                6/15/12 left I/o
                50%yolk sac 35%embryonal 15%seminoma
                No lvi markers normalized
                9/12 ct several enlarged retro peritoneal lymph nodes 3cm
                10/12 markers elevated
                10/15/12 3xbep
                1/13 complete response
                Surveillance

                Comment


                • #9
                  Hi Lori,

                  It is not unusual for the WBC to be low at this juncture and in some cases a ROUND can be delayed, though once it begins, it is not typically stopped for that.

                  Neutrogen or Neupropen would not help Eli with this round as I believe they are given in advance. It just depends on the Doctor or facility. Despite Austin's being very low, it was not recommended. It would be wise to keep him around as few people as possible and only "healthy" ones until his counts go up, which they should very soon. Once they start, they tend to spike up fast.

                  Eli should be given a sheet with instructions every day when he leaves the hospital. I believe a temperature of 101.3 is the cut off for calling in. They were especially careful, because of his port, about having us check Austin's temp on Bleo days.

                  If he had his blood drawn for markers last week, the results should be in. If they just did it today, the hCG should be ready tomorrow and the AFP probably Wednesday. Most likely they will have normalized, however that will NOT change the course of treatment!

                  You can't seem to catch a break with sick people in your family! Glad to today went better than the first round. It was the same for Austin.

                  Take care,
                  Diane
                  Cook/Maid/Chauffeur/ATM Machine/Personal Asst. to Austin

                  12/07/11 I/O AFP: 291 hCG: 151
                  12/08/11 CT Scan, Xrays - clear
                  12/15/11 Non Seminoma Stage1-B
                  EC, Teratoma, Yolk Sac, Intratubular
                  4/21/12 Relapse- Start 3XBEP
                  6/25/12 Finished BEP
                  7/02/12 Markers and CT Scan normal
                  10/3/12 3 month post-chemo check-up - All Clear!
                  2/28/13 8 month post-chemo check-up - All Clear!
                  6/30/13 ONE YEAR- ALL CLEAR!!
                  2/14/14 20 month post-chemo check-up - All Clear!

                  Comment


                  • #10
                    Thanks so much,as always , for your response diane. Today the nurse told eli his wbc had gone up a bit. The markers were drawn yesterday so dr should have hcg today or tomorrow....i want numbers!

                    Of all times for everyone in my family to come down with something! My husbands dr said he would no longerbe contagious after two days on antibiotics but were waiting until friday for him to come hometo be safe. On a good note, my older sons eye disease has been halted as the dr put it and he s tapering off prednisone!! It can reoccur but after one yearit seems to be improving. Cant wait to have e eryone healthy again!!

                    I read many of your posts ....have been a big help to me. Im so glad austin is doing well.

                    Lori
                    Eli s mom
                    6/15/12 left i/o
                    50%yolk sac 35%embryonal 15%seminoma
                    no lvi markers back to normal
                    Stage Ia surveillance
                    8/12 chest xray markers normal
                    9/12 ct retroperitoneal lymph nodes enlarged 3cm
                    10/12 markers elevated
                    Stage IIb
                    10/15/12 bepx3
                    Lori
                    Eli s mom
                    6/15/12 left I/o
                    50%yolk sac 35%embryonal 15%seminoma
                    No lvi markers normalized
                    9/12 ct several enlarged retro peritoneal lymph nodes 3cm
                    10/12 markers elevated
                    10/15/12 3xbep
                    1/13 complete response
                    Surveillance

                    Comment

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