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  • low white blood cell count question

    Hi everybody,

    I just had my third bleomycin infusion of my first cycle of chemo and prior to the treatment the nurse told me that my white blood cell count was extremely low. So low that they had to call my oncologist and get approval for the treatment today. He approved it as it was only the bleo today and I have an appointment with him tomorrow to discuss the first cycle. The question I have for you is what will be done about the low count? I have heard about getting Neulasta(sp) or Neupogen(sp) but it has not been mentioned by any of the nurses or my doctor(yet). If I do need one of these shots to help with the counts how long before the beginning of my next cycle do I need it? Cycle 2 begins on monday and I was really hoping to be able to go to the beach after my appointment tomorrow, I would rather not have to wait around on friday if I need to get a shot.
    Any help is very much appreciated, and I hope everyone is feeling as well as they can!
    Diagnosed 2/14/12
    Left i/o 2/22/12
    4.8cm Non-Seminoma 75%embryonal 20% chorio 5% yolk sac
    LVI present. numerous small lymph nodes on CT-largest11mm
    CT negative otherwise
    pre-i/o 2/14 AFP-129 B-HGC-3,644 LDH-319
    post-i/o 3/1 AFP-32.5 B-HCG-127 LDH-Normal
    3/15 AFP-normal B-HCG-149 LDH-Normal
    Started BEPx3 on 4/9

  • #2
    I would think your dr will prescribe you either neupogen or neulasta. (I'd ask for neualsta if your insurance covers it- it's only 1 injection compared to neupogen which is daily injections; only thing neulasta is wayyyy expensive.) Someone correct me if I'm wrong, but the next step after either neulasta/neupogen would be a blood transfusion.


    Also, be careful if you go out in the sun. Chemo really can effect your skin and cause quick sun burning, along with other issues. wear sunscreen
    sigpic

    Justin; http://www.facebook.com/justinkatuls
    Stage IIIB with mets to lungs; 100%EC; BEPx4

    http://youtu.be/hlsIwmtb0U8 Divine Romance, Phil Wickham

    Comment


    • #3
      Hu RoscoeP,

      I happened to ask the Nurse in the clinic the very same question today regarding Neulasta. It is typically given the day after your long week ( day 6). I don't know why, but I did read somewhere that it must be given no less than 24 hours after chemo is given. It is a preventative measure though, so once your counts go down, it is not effective, One of the PA's also told me it does not actually stop your WBC count from dropping, but rather shortens the length of time it drops, which can be very important if you become ill during that period.

      Should this be recommended for you, you may want to do some research here as well as just googling it. Many people have a wide range of unpleasant reactions to it, however, I have seen numerous times that Claritan D and Advil the morning of Bleo has really been beneficial.

      Best of Luck!!
      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


      • #4
        I just want to clarify.....from what was explained to me today, everyone's WBC is going to drop from chemo, some more than others, and that cannot be prevented. However, the length of time ( i.e. 4 days instead of 6) that it is low can be controlled with Neulasta as long as it is done ahead of time and not after the fact.

        Hope that makes sense now!
        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


        • #5
          I had my neulasta on the Mon following my long week, so I don't think the 24 hour thing is accurate? I could be wrong, but it seemed to do what my doc thought it should. Here's what drugs.com has to say about how it works:
          Neulasta (pegfilgrastim) is a colony stimulating factor. It is a man-made form of a protein (amino acid) that stimulates the bone marrow and promotes the growth of white blood cells called neutrophils in your body. White blood cells help your body fight against infection.

          Neulasta is used to prevent neutropenia, a lack of certain white blood cells caused by receiving chemotherapy.
          Full description here:
          http://www.drugs.com/neulasta.html

          I had no side effects from the injections, every guy is different.

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

          Comment


          • #6
            Thanks for your replies. I talked to my doctor about it today and he said that he expects my WBC to recover by Monday. If it doesn't he said I would probably get the Neulasta shot on Saturday, the day after my last EP treatment of cycle 2. He said that this is because you need 2 weeks in between the shot and your next EP treatment, bleomycin doesn't count.
            Diagnosed 2/14/12
            Left i/o 2/22/12
            4.8cm Non-Seminoma 75%embryonal 20% chorio 5% yolk sac
            LVI present. numerous small lymph nodes on CT-largest11mm
            CT negative otherwise
            pre-i/o 2/14 AFP-129 B-HGC-3,644 LDH-319
            post-i/o 3/1 AFP-32.5 B-HCG-127 LDH-Normal
            3/15 AFP-normal B-HCG-149 LDH-Normal
            Started BEPx3 on 4/9

            Comment


            • #7
              I believe what I read is that the shot has to be given no less than 24 hours after the last chemo treatment, which is why we were told Austin would come back on Saturday for it, were he to need it...or in your case Davespet, on Monday. The other parameter was it should be no less than two weeks prior to start of next round, not including Bleo. I believe I just googled it and saw this info on the company's website.

              I have no experience with the drug though and I know Davespet does. I just started researching it after hearing about some of the side effects. It seems people either swear BY it...or swear AT it.

              Best of luck whatever you decide!
              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


              • #8
                Originally posted by AustinsMom View Post
                I believe what I read is that the shot has to be given no less than 24 hours after the last chemo treatment, which is why we were told Austin would come back on Saturday for it, were he to need it...or in your case Davespet, on Monday. The other parameter was it should be no less than two weeks prior to start of next round, not including Bleo. I believe I just googled it and saw this info on the company's website.
                I recall some sort of restrictions my doc mentioned, but can't recall what they were exactly. That was why the shot was on Mon (3 days after my long week) & Bleo was pushed back to Tue when normal would have been Monday. It's likely safe to trust your doc to know how to deal with it all....

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

                Comment


                • #9
                  I always had my Neulasta the Sunday after my long weeks of EP and would always have Bleo the next day (on the Monday).

                  Comment


                  • #10
                    My husband got it automatically after he finished each of his long weeks. Treatment Mon-Fri then back Sat afternoon for the neulasta. We were told it needed to be within 24 hrs of his finishing chemo. I got the impression that was an insurance thing but can't say for sure. It did help his counts but he also had terrible back pain about a week after each of the injections and ended up going to the hosp for pain shots. I think some oncologists routinely prescribe it and others take a "wait and see" stance on the issue.
                    Tina, wife to Gene
                    Right I/O 2/21/11
                    60% embryonal carcinoma- 40% seminoma with L/V invasion, Stage 1B, Cat Scan- clear
                    HCG- 1.2, AFP-1.5, LDH-normal
                    BEP X 2 started 3-7-11
                    Bleo canceled for 2nd round, lung issues
                    EP 3-28-11 X 5 days, finished chemo 4-1-11
                    F/U cat scan 4/14/11 - Stable
                    3rd round EP as precaution because Bleo was cancelled, start 4-25, finished chemo 4-29-11, pneumonia 5-6-11
                    6-1-11, 8-3-11, 9-7-11, 10-19-11, 11-16-11, 12-18-11, 1-18-12, 5-8-12 Clear

                    Comment


                    • #11
                      From Drugs.com:

                      This medication should not be given within 14 days before or 24 hours after you receive chemotherapy
                      http://www.drugs.com/neulasta.html

                      So it's not *within* 24 hours it has to be *more than* 24 hours after chemo. Apparently bleo isn't a problem?
                      Jan, 1975: Right I/O, followed by RPLND
                      Dec, 2009: Left I/O, followed by 3xBEP

                      Comment


                      • #12
                        Yes, it is not less than 24 hours after you finish the long week of chemo. My husband had it on the Wednesday following the long week. It is the Etoposide (I believe) that bottoms out the WBC. My husband had the craziest blood work values during chemo while on Neulasta. The WBC never bottomed out - it was sky high, higher than before chemo began. Crazy stuff, Neulasta, but worth every penny.
                        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

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