Hospitalization for neutropenia with TC

Sharon, are you referring to Taxotere & Cytoxan (TC)?  My onco does give Neulasta automatically to patients getting Taxotere/Cytoxan.  I get my shot the day of each chemo infusion, although most women get theirs 24 hours later.  So far, my neutrophil counts on the day of my next chemo tx have been magnificent as a result.  My onco does not check them in-between unless I call to say I have a fever (temp greater than 100.4 degrees warrants a phone call, day or night).

It is true I think that the neutropenia is more severe during the first round of chemo when "bone marrow support" (Neulasta or Neupogen) is not used.  Even so, however, it could be bad enough to make you sick even during the later rounds.  Are you saying you were hospitalized during cycle #1, but your onco hasn't discussed what he will do next time?  I'm sure he has a plan.  Quite a few women have been put on Neulasta automatically once their counts went way low during round #1, but I don't know if all oncos do that.

There is a thread about Neulasta and Neupogen that I created awhile back, to discuss how those drugs work and what we've been told about them.  The thread is in the part of the BCO boards on "Chemotherapy".  I bumped it to the top of the list, so it should be easy to find (today, at least).  Check the Chemo topic for that thread.

otter

Sharon, Neulasta is a long-acting form of the same drug that's in Neupogen.  Neulasta is usually given well before the decrease in neutrophils, so it is probably correct that it won't work for you at this late point.  Day 13--wow!  When did you first start getting sick (febrile)?

I think most of the time when oncos are treating febrile neutropenia, they use antibiotics and Neupogen.  The Neupogen is given once the neutrophil count has dropped, and it is given every day until the count goes back up.  That could be as long as a week or more.

That's the advantage of using Neulasta instead--it's given ahead of time, in anticipation that the chemo will suppress the bone marrow; and you only need one shot.

I hope you are feeling better and out of there, soon!  Heck, this is supposed to be your "good" week coming up. 

otter 

Sharon,

To make your dx show up in your posts, go to the top of the page where it says, "My Home."  Click on that and then go to "My Profile".  There will be a tab on the "My Profile" page that says, "My Diagnosis."  Fill out that form with the relevant info.  At the bottom of the "My Diagnosis" page is a box you can mark that makes your diagnosis "Public".

No, I'm not done with my treatments yet.  I had my 3rd infusion of Taxotere/Cytoxan last Wednesday, so today is day 5 of cycle 3.  I'll be getting one more TC treatment on June 4 and then I'm on to an aromatase inhibitor for 5 years or more.  I already had surgery (mast/SNB) in February, and I don't need rads, so at least I'm relieved of that part.

There definitely are some disadvantages to the Neulasta and Neupogen shots, but it looks like the alternative can be even worse, right? 

otter 

Hi there, Sharon 

Sorry you're in the hospital!  I did not get Neulasta after my first tx, either.  I think my onc was trying to save money.  If you don't get Neulasta, then you will go back for bloodwork at about 10 days post chemo, and if the wbc is low, then you'll be given anti-biotics and Neupogen shots.  You will need to have 4 Neupogen shots, each given daily... they were just AWFUL!  I had the worst lower back pain!!  I didn't end up in the hospital, but that is the order of events for my 1st tx.  I was so upset, I told my onc nurse that I would insist from here on out, I WILL get Neulasta!  They listened, and I got Neulasta the next day following my tx.  If they don't give you Neulasta the day after tx, then you have to get Neupogen shots, I think.  I had to give them to myself, in my stomach.  The Neulasta didn't cause that terrible bone pain that the Neupogen did.

That was just my experience.

I hope you feel better soon!!

Hugs,

Harley

Sharon,

Hopefully your counts will be up and you go home.  I had 6 rounds of TC in 2007, never had a neulasta/neupogen shot and only had my counts drawn before each treatment which were 3 weeks apart.  My onc said that he only give neulasta to people that have their tx 2 weeks apart (dose dense) and my counts would natually come back up by the next treatment.  As time went by, my counts were borderline, but enough that I could get the chemo.

Best of luck!

Sharon,  As Harley said I strongly believe my onc was trying to save money too by not giving me neulasta.  I was doing TCH. (Taxotere, carbpotin, Herceptin)  After my very first round of TCH my counts were dropping. The 2nd wk they were really low. Third wk after my first infusion he calls me at home and says "Whatever you do, don't go out to eat or any where in public".  Sorry...TOO LATE...I just ate at Denny's!  He said he FORGOT to check my white count and I was down to "6".  (He KNEW I was low from the first week..no excuse for this!) So he said to come in the following day for neulasta.  Long story short I ended up in the hospital for 11 days and MISSED my 2nd infusion due to this.  I had a total of 21 days recovery before I could even start back on chemo which worried me because I am Her2/neu, 3+++, 5 positive nodes.  He had STRESSED to me BEFORE we started that whatever happened he wanted NO inturruptions of my chemo.  But yet the idiot doesn't give me my neulasta.  I couldn't even breath and was on oxygen & for at least 2 months after that. 

Make sure your onc gives you neulasta and ON TIME...not after the fact. Get your shot and you will be fine.  None of this is a cake walk...but I promise...you will get through all this.  Your off to a great start by asking questions and being an informed patient.  Be pro-active and always speak up.  That's half the battle.  Hang in there.

Chelee

whoa Chelee, that's awful!

I'm getting neupogen instead of neulasta (I'm sure it's a cost saving thing, but I keep forgetting to ask) and though I hate needles and it's one more stress for dh to help with the shots these stories help me be resigned to it.

Here's to rapid neutrophil production! Hope you get to go home today Sharon.