What if procrit does not work?

[nancym]

Hi all.

Thanks for all the support I have received so far. Mom went to her first doctor appointment today. I believe she has RA and the doc wants to try Procrit.

I understand it does not work for everyone…What might be some options if that is the case? BTW, she said her latest blood number came back at 9 (not sure cbc, hemoglobin etc). The once a week shots start next week.

Thanks again,

Nancy

[jaxem]

nancy
sounds like hemoglobin. 8 is usually the transfusion floor. Procrit & arenesp are erythropoiesis agents that can be used to stimulate red blood cell growth. they never worked for my wife either so she was destined to get packed red cell transfusions every 3 weeks or so. The problem with transfusions is they increase the iron content in the blood so after a period, you need to get rid of this excess iron usually with oral tablets like exjade (which are very expensive).

[nancym]

Hi Jack.

So if Procrit doesn’t work, the only alternative is transfusions?

Nancy

[Joan2438]

Not necessarily. Aranesp might work when Procrit doesn’t. My husband was on Procrit when Medicare quit paying for Aranesp. Procrit didn’t do as good a job as Aranesp in keeping HGB up but did keep him from needing transfusion. With Procrit HGB was in high 9’s. When he went back on Aranesp, HGB finally got up to 10.

Good luck.

Joan

[nancym]

Thanks Joan.

Do you have any idea why one worked better than the other? Are they two different classes of drugs or just different formulations of the same thing?

Nancy

[Joan2438]

Sorry. I have no idea on. They are both EPOs. I know Dr. thought Aranesp was better for Don’s MDS-RA. I have read other places that Procrit works better for some and Aranesp for others. Go figure. I can’t.

Good luck!

Joan

[billboy]

Hi Nancy,

As I see it, your options include at least the following (in an attempt to increase your mother’s hemoglobin):

– Procrit, with dose adjustments as necessary
– Aranesp, with dose adjustments as necessary

Both of these drugs are unlikely to work if your mother’s EPO level at start is > 500. I believe these drugs are bilogically the same as a patient’s EPO (hormone produced by the kidneys).

– Dacogen, a low-dose chemo drug
– Vidaza, another low-dose chemo drug

I had the same diagnosis as your mother and my doctor tried Procrit, then Aranesp, and then Dacogen (which was the only one that worked in my case). By the way my doctor never measured my EPO before initiating drug treatment. Maybe doctors are hoping for at least a placebo effect when trying to increase HGB.

Following four cycles of Dacogen treatment, I finally achieved transfusion independence, if barely. My HGB hovers in the 9 – 10 range, but at least it hasn’t fallen below 9 in the last 19 months. Hope your mother does well with just the drugs.

[nancym]

Thanks Bill. I found your post helpful. I am trying to anticipate the best I can. I don’t want to buy tomorrow’s trouble today, but I do like to have choices…

Nancy

[billboy]

Hi Again Nancy,

Forgot to mention Revlimid as another possibility for your mother. There has been a pretty good response by patients with the 5q chromosome deletion. Don’t remember the exact % of those responding. My doctor put me on it even though I didn’t have the aforementioned deletion. Didn’t work as noted in my identity line.

[jaxem]

bill
let’s be sure everyone understands that aranesp & procrit are EPO drugs that attempt to increase red blood levels (anemia) whereas dacogen & vidaza are hypomethylating drugs which in no way will increase red blood levels per se. dacogen, vidaza & revlimed alter the scheme of blood cell production.

[billboy]

Jack,

Granted, that Revlimid, Dacogen, and Vidaza are not the same class of drugs as procrit and aranesp. However, Revlimid, Dacogen and Vidaza all have the prospect of an increase in HGB. See the following:

Revlimid http://ir.celgene.com/phoenix.zhtml?c=11…&highlight=

Dacogen http://www.mgipharma.com/pdfs/dacogen_pi.pdf

Vidaza http://theoncologist.alphamedpress.org/cgi/content/full/10/3/176

These three drugs are typically not used until transfusion dependence ensues.

[jaxem]

Bill
The only method that these drugs will increase HGB is that will minimize or hopefully eliminate the harmful aspects of the MDS which in turn will allow the body to begin producing good cells again. Although a patient has become transfusion independent, any of these drugs may and usually is given until a prescribed cycle for the drug is completed.

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