Neupogen question

[katiebear]

My dad has been scheduled for a SCT for 4 months in a row, and for various reasons, all have been rescheduled. Last Monday he went for his weekly CBC, and his whites were low as usual. Being that he was getting a bone marrow biopsy on Wednesday, his oncologist wasn’t sure if he should get the shot of neupogen. They went ahead and gave it to him anyway. He went for the biopsy on Wednesday, and Sloan called him and told him it had to be redone because of too many blasts. According to my dad his doctor at Sloan thought the test results may have been skewed because of the neupogen shot. He had to go back yesterday for another biopsy, and the same results turned up. Can neupogen actually skew test results? It seems to me that maybe there is some other reason. His platelets and red blood cells are better than ever, only his whites are low. His doctor told him that she is baffled and has never seen anything like this before. He didn’t ask his blast count which totally frustrates me. Does anybody else have any experience with this? Any help would be greatly appreciated.

Katie

[patti]

Our experience with neupogen is that it doesn’t actually work for at least a week. Hence, a shot taken on Monday one week won’t begin working until the following Monday (or thereabouts). We only discovered this when mom went to get her picc line put in. She gave herself shots 7 days in a row but those shots didn’t actually produce large quantities of white cells until a full 7 days AFTER the last shot. So it was 14 days from the first shot. The radiologist that did the picc said this would happen. The oncologist said mom would have white cells immediately. Later the doctor admitted that the radiologist was correct. So, guess the radiologist knew a little more about this one…..We don’t see that doctor anymore (not for that reason, but it didn’t bode well for the doctor as far as we were concerned). We’ve found the reverse to be true also. Since mom gives herself shots 2x’s a week, we noticed that if she misses a week she still has white cells the following week due to the shots the week before. Her counts don’t actually drop until a week later.

Not sure if this is “supposed” to happen, but it’s what happens to my MIL.

As for the blasts, it’s possible his blast count has increased due to the disease itself and Sloan won’t do a transplant? That doesn’t make much sense since they do chemo/radiation in prep for a transplant, but it’s a possibility.

patti

[katiebear]

Patti,

I didn’t realize it took a week for the neupogen to kick in. My dad usually gets a shot on a Monday, and by the following Monday, his whites are extremely low again. He has to go back in two weeks for another biopsy. They won’t do the the transplant with the blasts because according to the doctor it will increase his chances of the mds coming back. Thanks for your help.

katie

[jaxem]

katie
same thing happened to my wife; results were skewed in that flow cell cytometer recorded 2% blasts but visually (under microscope) looked more like 8%. another BMB taken about 3 days later recorded true blast count of 5%. I thought neupogen shots take effect quickly, last about a day or so. Neulasta shots last about a week.
jack

[patti]

You’re actually both right. Neupogen *is* supposed to work fast – but what we’ve found by testing things out is that it doesn’t always.

I don’t think there is any real scientific reason it happens, it seems it just depends on the person’s body. Maybe it has something to do with how well (or how not well) there bone marrrow is functioning. Maybe sometimes it just takes longer for those stem cells to mature and kick out the cells. If that were the case, it would make sense for my MIL’s case because her bone marrow is nearly completely non-functioning. Don’t know.

HTH

patti

[katiebear]

Jack,

I was pretty sure the neupogen doesn’t last that long as at one point he had three shots in a week. I have a feeling that his disease is progressing. He didn’t ask his blast count which drives me nuts. I don’t think he wants to know. He gets another BMB in a couple of weeks, and I guess we’ll know more then. He’s been on Vidaza for 8 months which seems to be working for his reds and platelets, they are within normal range. Thank you for your response.

Katie

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