Couple post-ATG questions

[lacanada1]

Hi everyone

So, I've just been released from hospital having my first round of ATG. I had some of the usual reactions. It was a long slog, but I got through it. Now, the wait for a (hopeful) recovery begins. I had a couple questions that I wanted to put out there to those who have had ATG in the past:

1. Serum Sickness: I've noticed that I have large rashes on my arms, legs and torso, a lot of which has turned into what looks like petichae, or even un-raised chicken pox. It is lightly 'hot/itchy' when I press against it, but otherwise it really doesn't bother me. Does anyone have experience with this kind of skin manifestation? Will it just go away with time? I also have joint pain.

2. Use of GCS-F during period following ATG. The ATG really took a beating on my WBC count so they have been presricibing me some GCS-F to push those counts up. Thing is, to me, it seems a bit counter-intuitive since the whole point of ATG is to supress T-lymphocites to allow the marrow to heal, correct? I'm following the doctors' orders and taking the GCS-F, but just wondering if anyone out there has heard of any counteractions between ATG and GCS-F.

Looking forward to any insight you may have.

Cheers

[Marlene]

The GCSF is a growth factor for the neutrophils and not the lymph white blood cells. The neutrophils are key to fighting infections. While the lymph cells, are the ones they are suppressing. The lymph cells are the ones implicated as the troublemakers in autoimmune diseases. So GCSF should not be a problem.

I can't help you on the ATG reactions but from I understand, most are on steroids to prevent serum sickness. If you are not and are experiencing joint pain, I would call your doctor. GCSF can also cause bone pain and if it's bad, they will prescribe a pain med.

Best of luck on your recovery.

[ssdavi71416]

Dr Young and Scheinberg ( World Experts on Aplastic Anemia) Wrote an article recently published in the Blood Journal that discusses how they treat Aplastic anemia. (published April 12, 2012) This article discusees the recommended protocol using ATG/ cyclosporin.

http://bloodjournal.hematologylibrar...1185.full.html

I had my ATG treatment the beginning of April this year. I was on predizone for a couple of weeks after ATG to reduce the likelyhood of serum sickness issues with ATG treatment. I know one side effect of aTG is a rash. The Dr looked for a rash each time I was in her office. (weekly)

From what my Dr said she did not want to put me on any growth factors because she wanted my marrow to reginerate. I was however on an antibiotic, antiviral and antifungal medicines until my nuetrophil count was above 1000 or 1 depending on the scale used. Platelet trnsfusions were on ordered when I was bleeding. I was on aminocaproic acid until my platelets were above 20.

I am also still on cyclosporine.

Good luck with your treatment.

Scott Davidson

[Ellen McDonough]

I had that same kind of rash all over my body post ATG that looked like purple petechiae with raised red lesions . It was warm to touch.I recall I even had it on the soles of my feet.The hematologist I had hadn't ever seen it following ATG.I had received Iv steroids pre ATG infusion because of respiratory allergic reaction which worked.We ran ATG very slowly as well.The rash eventually went away on it's own over the coarse of 1-2 weeks.I was not treated with any medications for it.My hematologist consulted with doctors at Fred Hutchinson Cancer Center who were very familiar with aplastic anemia treatment.
I was taking GCSF for a short time after ATG but changed hematologists to the doctor I continue to be treated by today who discontinued GCSF when I came under his care shortly after my ATG.
Just wanted to respond and let you know that the rash is a reaction most likely . Also- I think GCSF is not used as prevalently as it once was .
Good luck- as remember the rash was quite uncomfortable.Hope you feel better soon!!

[evansmom]

Hi there,

I echo Marlene's response completely.
I believe the rash and joint pain are, indeed, serum sickness and if you're not on short term prednisone, you should be. If you're already on prednisone, perhaps you need a higher dose. Either way, speak to your hematologist.
The G-CSF is important to keep you infection free as you recover from the ATG and for the next 4 weeks or so, while you're on the prednisone.

Wishing you a complete recovery,

[Lisa V]

Best to have the rash checked out by a dermatologist before jumping to any conclusions. It may be serum sickness, but Ken also developed a rash post-ATG, which our hem/onc suggested treating by increasing his prednisone dosage. We were wary of doing so, since he was having several bad side effects to the prednisone already, and the rash wasn't bothering his as much as some of them. We consulted our dermatologist, who immediately recognized the rash as yet another prednisone side effect. Sure enough, when we REDUCED his dosage, it went away. Imagine what would have happened had we increased it!

[lacanada1]

Thanks everyone for the advice. The rashes have since gone away -- my docs said it was serum sickness for sure. Counts are looking up too. Still too early to tell, but hopeful this ATG has done something right!