I need advice desperately,
My dad is on Velcade, cyclophosamide and Dex for his myeloma treatment. His neutrophils have been decreasing since he started treatment. He has been off cyclophosamide for 2 treatments and then started neupogen to restart the cyclophosamide but at a reduced dosage.
Last week, he was given reduced dosage again and 3 consecutive days of neupogen thereafter.
The sad thing is, my dad's neutophil counts are at a low of 400+ and he has to stop the combo treatment today.
It is either the neupogen not working or the cyclophosamide being too harsh on dad.
What can he do now? Is there an alternative to cyclophosamide that will not wipe out neutrophils?
His primary doctor is sick today so another doctor covered her. We have to wait till next week when she is back...
Pls help
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Re: pls help......Neutrophil counts dropping
Dear Phoebe,
Low neutrophils are usually a result of chemotherapy, the myeloma itself, or both. Occasionally another cause (e.g. a viral infection, or another medication like an antibiotic) can also be a contributing factor. Neupogen usually helps shorten the length of time that the neutrophils are low, but can't always prevent it. There are a number of options for your oncologist to consider, depending on the situation. These include increasing the duration of the neupogen treatments, switching to a weekly Velcade schedule (if given twice-weekly currently), or lowering the dose of the cyclophosphamide. If the neutropenia persists, then sometimes we have to drop the cyclophosphamide or switch to another drug: if a velcade-based regimen is preferred, then options include switching cyclophosphamide to thalidomide or increasing the dexamethasone dose, since these 2 drugs have minimal effects on the neutrophil count. The important thing is to discuss all of these options with his oncologist, and I'm sure a solution can be found.
Hope this is helpful.
Best regards,
Adam Cohen
Low neutrophils are usually a result of chemotherapy, the myeloma itself, or both. Occasionally another cause (e.g. a viral infection, or another medication like an antibiotic) can also be a contributing factor. Neupogen usually helps shorten the length of time that the neutrophils are low, but can't always prevent it. There are a number of options for your oncologist to consider, depending on the situation. These include increasing the duration of the neupogen treatments, switching to a weekly Velcade schedule (if given twice-weekly currently), or lowering the dose of the cyclophosphamide. If the neutropenia persists, then sometimes we have to drop the cyclophosphamide or switch to another drug: if a velcade-based regimen is preferred, then options include switching cyclophosphamide to thalidomide or increasing the dexamethasone dose, since these 2 drugs have minimal effects on the neutrophil count. The important thing is to discuss all of these options with his oncologist, and I'm sure a solution can be found.
Hope this is helpful.
Best regards,
Adam Cohen
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Dr. Adam Cohen - Name: Adam D. Cohen, M.D.
Beacon Medical Advisor
2 posts
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