Monday, May 24, 2010

Neupogen and WBCs - so far, so good

In addition to getting Pete out last week, the big going-on was that I got five shots of Neupogen. This is a drug that stimulates your bone marrow to make more white blood cells. There's some anecdotal evidence in the medical literature that Neupogen given with Bleomycin can cause lung toxicity (translate this to be permanent scaring of your lung tissue). Consequently, lots of oncologists are hesitant to use it in conjunction with ABVD. We've been dancing around this issue for the last 2 months. The issue really started after my bone biopsy, where the report indicated that I didn't have  a very high density of cells in my bone marrow that make WBCs. Start from a not-so-much level and then add 5 doses doses of ABVD and in my case, you end up with some very low white blood cell counts. Using one formula (ANC #) a value < 1680 is not normal, < 1000 means you're at risk of infection, < 500 means you're at very serious risk of infection. My ANC # a week ago was 300. Uggh. Another big piece of the overall Hodgkins success mantra is "full dose of ABVD, on time." And if you get an infection, that's at risk. And if you get an infection in your chest, you can be really in trouble. So out with Pete and we decided to take the risk of some lung scarring to keep me dosing on time and at full strength.

So with all that preamble, the results of the week were pretty good. Compare my blood work from today vs. a week ago:
  • ANC # from 300->1800 (6 x improvement and back into normal range, which is 1680 < x < 6160)
  • WBC from 1420->3080 (> 2 x improvement, much closer to the low end of normal which is 3830)
This should help me avoid any infections and increase my chances of staying on time, on dose for the last 7 treatments.

The downside of this added protocol was that it made me feel slightly blechy. When your bone marrow is making that many new WBCs, you can get some side effects. One of them is bone pain, which can be pretty uncomfortable but I didn't experience that. What I did experience was some nightly rise in body temperature. My temp has been running around 97.5 in the morning and I've been taking it pretty religiously because a spike in body temperature is a strong indicator that you're getting an infection. A couple of nights last week I was running around 99.5 before going to bed. In both cases I took some Ibuprofen and my temp was down in the morning. So nothing really bad but just another of the set of minor yuckys (yes, that is a word - at least in my vocabulary!) to deal with.

I'm hopeful that this dose will keep me in a good place in terms of blood chemistry for the rest of my treatments. We'll see!

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