Neulasta Question

[Alice P]

Does anyone know if Neulasta can suddenly stop working? My husband has been getting an injection every two weeks for the last sixteen months and has always experienced a pretty good bump in his WBC and neutrophils. After last Tuesday's shot, however, his WBC only went from 0.8 to 0.9, and his neutrophils dropped from 0.3 to 0.2. I wasn't able to go to his appointment on Tuesday and on Friday questioned whether he had actually received the shot. The nurse assured me that he had. What could be going on?

[Birgitta-A]

Hi Alice,
The WBCs will decrease if we get an infection because our bone marrow can't make up for the WBCs that are killed when they fight the infection. When the WBCs are as low as your husband's you can get infections from your own body. You probably know this and I suppose he is very careful. Look at info for neutropenic patients. He should control his temperature morning and evening.

I have not been able to find any info about how long Neulasta is working. I think that patients like your husband who get a good response often continue with this treatment during many years. I have been taking Neupogen during 4 years with good effect. Neupogen is more easy to monitor than Neulasta.

Hope your husband can get effective help!
Kind regards
Birgitta-A

[Alice P]

Thanks for your reply, Birgitta. John does not seem to have any other symptoms of infection, although his ferritin has spiked in recent weeks. His hematologist has put the Revlimid on hold due to his suppressed counts. I think they erred about 10 days ago when they allowed his Hgb to get down to 7.0 and his platelets to 12 on a Friday, so he had to wait until Monday to get transfused. He required additional (!) transfusions of red cells and platelets on Wednesday and Friday. We were waiting at the doctor's office at 8 am Friday to inquire about the low WBC. We didn't get to see the doctor, but when the nurse called him, he ordered a 5-day course of antibiotics. I can't believe the nurse hadn't noticed the low WBC when he had his last CBC on Thursday. It just goes to show you how vigilant the patient and caregiver have to be about checking those numbers.

[Birgitta-A]

Hi Alice,
You know when the neutrophils are as low as 0.2 the risk for infection is very high - good that you managed to get antibiotics! Some members of this forum can have very low neutrophils but most of us need at least 0.5.

As you probably know the ferritin value will increase when we have an infection. John can have something that doesn't give much symptoms. Hope the antibiotics will have good effect!
Kind regards
Birgitta-A