Neupogen

[Chirley]

Hi, I was wondering if anyone else had been told that having Neupogen injections can prompt the bone marrow to produce leukaemic cells ?

My neutrophils have only been above 1.0 twice in the last year or so and then it was only when I was on Prednisone. The last time they went down to 0.4 the haematologist told me that he would have started me on Neupogen injections except that he was a little worried that it would also increase the production of any potential leukaemic cells as well. I don't think I'm at any particular risk of leukaemia (any more than the rest of us with bone marrow problems, I mean).

I work dealing with sick and infected people and would feel a lot more secure if I was having the Neupogen injections to provide some kind of protection but at the same time, I definitely don't want to provoke leukaemia either.

Also, at my last visit, he said that I would not meet the criteria for having Revlimid because I am no longer considered low risk ,because I have 2 cell lines affected and that if I were to start treatment it would have to be Vidaza (7 days in 28) and he would like to postpone starting this for as long as possible while I'm still able to tolerate the frequent transfusions. This sounds good to me but I'm a little worried that putting off Vidaza will cause the disease to be more intractable to treatment later on. I didn't think of asking him about this when I was there.

I worked with someone today who's daughter has swine flu and also had to visit 2 people with confirmed swine flu...eeek. It seems to be every where but then, that is what my job is about. My hands have never been washed so much and that alcohol hand rub is invaluable. I haven't been fitted for a mask but I wear a generic disposable mask that we use for TB precautions.

I now have 2 days off work and intend to stay home and protected from the flu. Also, a bit of me time sounds good anyway.

Chirley

[Birgitta-A]

Hi Chirley,
Neupogen (G-CSF) has always been suspected of increasing the risk for AML. Many studies on MDS patients have showed that there is no increased risk for AML transformation :
http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

Other studies have showed that Neupogen in cancer patients with neutropenia after chemo there is a risk for worse disease:
http://www.oncologystat.com/news-and...ndrome_US.html

I have to take Neupogen 2 injections/week since neutropenic fever Sept 2007 and hope for the best.

Vidaza is perhaps a better drug for most MDS patients than Revlimid bur your doctor is wrong telling you that you belong to the high risk group only because 2 cellines are affected. There are many systems for classification of MDS and one of them you look at blastcells in the bone marrow, chromosome aberrations and number of cytopenias (few cells) (slide 8).
http://www.ebmt.org/ebmt_2009_slide_bank/209.pdf
If you have less than 5 % blast cells in the bone marrow and no chromosome aberrations you belong to the low risk group .

Kind regards
Birgitta-A