ATG Treatment

[Johntand]

My 22 year son was recently diagnosed with SAA. Began ATG and cyclosporine plus promacta on 5/30. Within the last few days he has excruciating pain in his knees. Dr. Believes it is from the bone stimulator shot that he received while in the hospital. Anyone have this issue and more importantly anything help alleviate the symptoms. The doctors have suggested Claritin but it doesn?t seem to help.

[Neil Cuadra]

Johntand,

I'm sorry to hear about you son's knee pain. Do you know more about the specific drugs and shots he received or is receiving?

I'm not an expert, but I'll tell you what I've read about this type of problem.

Did your son receive the GCSF (granulocyte colony-stimulating factor) drug named Neulasta (pegfilgrastim)? It can increase histamine, which can result in inflammation and pain. To counter this side effect, Claritin (loratadine) and/or Pepcid (famotidine) have been found to help some but not all patients. They aren't strong medicines, but they are safe to try.

If he's no longer receiving the treatment that caused the pain, this symptom could fade on its own. When it comes to side effects, it's the continuing treatments that are the highest concern. But of course pain like this is awful even if it's expected to be temporary.

It would be worth knowing any additional medicine, other than the ones you mentioned, that your son is receiving, such as Epogen (epoetin alfa), prednisone, etc. so you can be aware of all the side effects he might have to watch for.

To deal with the knee pain, you or your son could discuss, with the doctor, changing the treatment schedule or using stronger medicine to lessen this side effect.

And, just to be complete about the possibilities, pain can also be from causes unrelated to his SAA treatment or a separate medical condition that has resurfaced or has been exacerbated by the SAA treatment. But that doesn't seem especially likely if he's never had knee pain before.

[Johntand]

Yes. Pegfilgrastim is the drug. We spoke to the Dr. And he is going to move away from that given the pain and he will start taking Vantin. Also switched to atovaquone instead of penxamidine. Also backed off on the prednisone taper. Given all of that, you are right about the symptoms getting better. Last night was first night in a week that he was able to sleep pain free. Although he did take a heavy pain pill before he went to bed. Thank you.