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Old 09-23-2010, 12:59 PM
gwenllian111 gwenllian111 is offline
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Join Date: Sep 2010
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Default A few questions


I'm new, and i'm terrible sorry if i've posted in the wrong part of the forum. I'm not quite sure where I belong!

I have a bit of a history with neutropenia, and admissions with being on broad specturem anti biotics. I'm currently neutropenic with my neuts at 0.2, WBC 1, and HB 11.4.

I wondered if I could have bone marrow cancer, but my hb is only down a bit. I'm seeing a haematologist tomorrow, but in the mean time, I wondered if anyone could shed a bit of light on this.


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Old 09-25-2010, 05:41 PM
gdpawel gdpawel is offline
Join Date: Feb 2007
Location: Pennsylvania
Posts: 4,360


Complications of cytotoxic chemotherapy are more common in older patients (65 years of age and older) with cancer than in younger patients, and the occurrence of myelosuppression, mucositis, cardiodepression, peripheral neuropathy, and central neurotoxicity can complicate treatment.

Age-related physiologic changes that can increase the toxicity of chemotherapy are decreased stem-cell reserves, decreased ability to repair cell damage, progressive loss of body protein, and accumulation of body fat.

A decline in organ function can alter the pharmacokinetics of many of the commonly used chemotherapeutic agents in some elderly patients, making toxicity less predictable. Comorbidities increase the risk of toxicity through their effects on the body.

Furthermore, the drugs used to treat comorbidities may interact with chemotherapeutic drugs, potentially increasing toxicity in elderly patients. Prospective trials in older patients with solid tumors have found that age is a risk factor for chemotherapy-induced neutropenia and its complications.

In clinical trials, the incidence of moderate to severe neutropenia (a form of low white blood cells) and of neutropenia with fever was higher in patients receiving certain myelosuppressive chemotherapy (chemotherapy that can suppress the production of blood cells by your bone marrow) versus chemotherapy alone.

There was an increased incidence of anemia (low red blood cells), leukopenia (a form of low white blood cells), diarrhea, and infection with combination chemotherapy.

Source: Genentech

Because everyone is different, it is not possible to predict what side effects any one person will have. If you have questions or concerns about side effects, make sure you have a good talk with your doctor.
Gregory D. Pawelski
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Old 04-08-2012, 11:24 PM
gdpawel gdpawel is offline
Join Date: Feb 2007
Location: Pennsylvania
Posts: 4,360
Default White Blood Cell Boosters vs Red Blood Cell Boosters

Granulocyte colony-stimulating factor is one of the about 15 proteins known to activate endothelial cell growth and movement. At a critical point in the growth of a tumor, the tumor sends out signals to the nearby endothelial cells to activate new blood vessel growth.

A growth factor is about twenty small proteins that attach to specific receptors on the surface of stem cells in bone marrow and promote differentiation and maturation of these cells into morphotic constituents of blood. And blood is a circulating tissue composed of fluid plasma and cells (red blood cells, white blood cells, platelets). Problems with blood composition or circulation can lead to downstream tissue (which is made up of cells) dysfunction.

Colony-stimulating factor = A substance that stimulates the production of blood cells. Colony-stimulating factors include granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage colony-stimulating factor (GM-CSF), and promegapoietin.


White Blood count boosters = Neupogen (Filgrastim ), Neulasta (Pegfilgrastim), Leukine (Sargramostim)

Red Blood cell boosters: Procrit, Epogen (epoetin alpha, Erythropoietin), Aranesp (Darbepoetin)

The agents include epoetin alfa (Epogen, Procrit), epoetin beta (NeoRecormon), and darbepoetin alfa (Aranesp). Neulasta has to do with wbc (white blood cells) and procrit has to do with rbc (red blood cells).

Blood is a circulating tissue composed of fluid plasma and cells (red blood cells, white blood cells, platelets). Problems with blood composition or circulation can lead to downstream tissue (which is made up of cells) dysfunction.

The big difference is that white blood cells help fight infection, red blood cells transport oxygen throughout the body.

Erythropoiesis is basically a process where hemoglobin is synthesized, and eventually passes into the bloodstream.

Erythroprotein (EPO) is a natural substance made by the kidney.

Pharma EPO is a hormone that stimulates bone-marrow cells to produce red-blood cells.

Tumors create their own supply lines by secreting substances that stimulate the formation of new blood vessels. Pharma EPO is helping them along (growth factor).

Drugs that would stimulate white blood cells would not involve erythropoiesis (above). They would be involved with leukopoiesis, the process of making leukocytes, stimulated by various colony-stimulating factors (CSFs), and hormones produced by mature white blood cells.

Growth factors cause endothelial cell (the cells that line blood vessels) to produce chemicals that break down the nearby tissue and the extracellular matrix (the spaces between cells). Then the endothelial cells divide into more cells and begin building new blood vessels. Other elements, such as stromal cells (cells that form connective tissue), provide "structural support" for the new blood vessels.

It is recommended to cut down on the use of granulocyte CSF (G-CSF) products for the primary prevention of the chemo-induced adverse effect of febrile neutropenia. ACSO guidelines state that G-CSFs are recommended in patients who have a "high risk" (more than 20%) of developing febrile neutropenia as a complication of chemotherapy (J Clin Oncol. April 3, 2012).

In practice, there is a clear overuse of these agents. Use is inconsistent, the products are used both appropriately and inappropriately. These products are costly and should be used only in patients who are at high risk of developing febrile neutropenia, as specified in the guidelines.

[url] l2012

FDA Strengthens Warning on Drugs prescribed for Anemia in Cancer Patients

Gregory D. Pawelski
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