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Cherseybear View Drop Down
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    Posted: Feb 18 2010 at 3:36pm
Hi Everyone,
 
I've been on Cisplatin since December and my bloodcounts are dropping slowly and regularly.  My doc has been reducing the chemo  dose but the numbers continue to go down.  I was already upset about the reduced dosages so when I was sent home today (platelet count way too low) I was a mess.
 
I guess I have a couple of questions and wonder if anyone can help me.
 
Does anyone know how long it takes for platelet counts to recover?  Can anyone tell me what dosage of Cisplatin they received (I'm three weeks on and one week off and have gone from 42mg per treatment to 32mg per treatment) over the last few months.  Would you think that last weeks' treatment is still killing cells and that's why my counts continue to drop?  If you continue to reduce the dosage of the chemo treatment at some point does it become ineffective?
 
Any answers, help, or advice would be appreciated.  My doc's away so I can't even ask her, and in alot of ways the people on this board always seem to have the best answers.
 
Thanks a bunch.
 
Cheryl
 
 
 
 
 
I
Dx. 03/07/08 - Masectomy & node dissection 22/07/08. IDC, 8/14 positive nodes, Grade 3/Stage 3C. Tx - 4DD AC then 4DD Taxol. Avastin - Beatrice Study. 30 Rads. Liver Mets - November '09.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote dmwolf Quote  Post ReplyReply Direct Link To This Post Posted: Feb 18 2010 at 4:11pm
Hi, Cheryl.  I looked it up, and low platelets is called thrombocytopenia.  It happens 6-8 days following chemo and takes days to recover.   What might happen is that with ongoing chemo, the poor cells don't have a chance to fully recover, so they keep dipping down then coming up dipping down and so on, all the while never really coming back to healthy levels.   I had this happen when I finished my chemo marathon.  My platelets and red blood cells were super low - it took about 6 weeks for them to come back to normal.     Cisplatin is an especially hard drug on bone marrow (the whole phenomenon is bone marrow suppression).    Your options are to 1) take a break, 2) lower your dose, 3) space out treatments more, 4) get platelet transfusions, or 5) take a drug that stimulates red blood cells and platelets.   The drug option is controversial, because it has growth factors that could potentially interact negatively with your cancer.  I don't know anything about cisplatin doses or lowest effective dose, unfortunately.  Are you on anything with the cisplatin, or are you taking it alone?  Why did you start with cisplatin?

Love,Denise
DX 2/08@43 stg II IDC; gr2,0 nodes. Neoadj chemo, first ACx2 (fail) then CarboTaxotereX6(better). Lump, Rads done 11/08; Clodronate. False alarm queen: PetCT lung & TM marker. NED. PBM w/recon 9/10.
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Thanks for replying Denise.
 
I did the marathon DD ACT with Avastin (Beatrice) for a year.  Had two months of good health and relapsed with mets to my liver.  I was supposed to be on a Cisplat/Gem combo but my liver was in such poor condition (ie. covered in tumours - big ones) that it couldn't handle the Gemcitabine, so we tried Cisplatin on it's own and I've been having good results as far as the liver goes, just been hard on my blood counts.
 
With the cutback on the dosage and today being sent home I'm really freaked.  Starting to imagine all kinds of symptoms, etc.  I was doing really well so I'll have to try and put myself back in my "happy place" and just living.
 
Cheryl xo
Dx. 03/07/08 - Masectomy & node dissection 22/07/08. IDC, 8/14 positive nodes, Grade 3/Stage 3C. Tx - 4DD AC then 4DD Taxol. Avastin - Beatrice Study. 30 Rads. Liver Mets - November '09.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cg--- Quote  Post ReplyReply Direct Link To This Post Posted: Feb 18 2010 at 7:56pm

Dear Cheryl,

This was just published in the New England Journal of Medicine.  Plus, I am trying to find an article I had seen for the metronomic low-dose cisplatin.....Many times the chemotherapy is more tolerable for our bodies to handle when given on a weekly basis. 

 
See if that would be an option, plus platelet transfusions, I guess I am suggesting running it by the oncologist, a little bit of chemotherapy and a little bit of platelets to keep you on a slow steady course of keeping the liver tumors under control.
 
Low-Dose Platelet Transfusions Deemed Safe

By Ed Edelson
HealthDay Reporter

WEDNESDAY, Feb. 17 (HealthDay News) -- A lower dose of platelets than is commonly used is safe for people who require transfusions of the clot-forming blood cells, a new study shows.

 

That's good news for people getting chemotherapy or bone marrow transplants because platelets are often in short supply, said Dr. Victor M. Aquino, a member of the research team whose findings are reported in the Feb. 18 issue of the New England Journal of Medicine.

Frequent platelet transfusions -- once or even twice a day -- are needed for such patients because "chemotherapy damages the bone marrow and causes the body not to produce platelets," said Aquino, an associate professor in the pediatric hematology-oncology division at the University of Texas Southwest Medical Center. "They need to be replaced to prevent bleeding."

The study included 1,272 people who had at least one platelet transfusion. They were divided into three groups, depending on the number of platelets in each transfusion. The high-dose group got the usual amount, roughly 10 trillion cells, and the low-dose group got half that number.

The researchers observed no significant difference in the amount of bleeding among the three groups, the report said.

"You can safely transfuse patients with about one-third the dosage of platelets we normally use," Aquino said.

More frequent transfusions were required for the low-dose group, "but you use fewer platelets in the long run," he said.

Another major finding was that it's safe to allow the blood platelet count to go lower than what is now regarded as the danger point, said study author Dr. Sherrill J. Slichter, a professor of medicine at the University of Washington and director of platelet transfusion research at the Puget Sound Blood Center.

Platelet transfusions are commonly given when blood levels drop below 10,000 cells per cubic millimeter of body-surface area. The study found no danger when platelet counts went as low as 5,000 per cubic millimeter. "As long as you have a morning platelet count of at least 5,000 or greater, the risk of bleeding is essentially the same," Slichter said.

The findings will almost certainly change clinical practice, Slichter and Aquino said. "In our patients, we now transfuse at the lower number," Aquino noted.

Reducing platelet usage would have a number of benefits, Slichter said. "It's an expensive product, and if you can use fewer, that is a cost savings for patients, insurers, hospitals and blood centers," she said.

Platelet supplies must be renewed constantly because they don't last long outside the body, she said. "They have a half-life of five days," Slichter said. "The half-life of red cells is 43 days."

Publication of the study results "hopefully will change transfusion practice," she said.

"In the dose range we used, there was absolutely no effect of dose on the risk of bleeding," Slichter said. "Smaller doses are as hemostatically effective as larger doses."

"This is very good news," said Dr. Donna L. Skerrett, director of transfusion medicine and cellular therapy at New York-Presbyterian/Weill Cornell Medical Center in New York City. "It answers a question that has been asked for quite a while: whether platelet dosage really matters."

Because of the short half-life of platelets, supplies often drop during weekends and because of storms or even holidays, Skerrett said. "It is extremely valuable to know that dosage can be reduced at those times with no harm to patients," she said.

Copyright © 2010 HealthDay. All rights reserved.

SOURCES: Victor M. Aquino, M.D., associate professor, pediatric hematology-oncology, University of Texas Southwest Medical Center, Dallas; Sherrill J. Slichter, M.D., professor, medicine, University of Waashington, and director, platelet transfusion research, Puget Sound Blood Center, both in Seattle; Donna Skerrett, M.D., director, transfusion medicine and cellular therapy, New York-Presbyterian/Weill Cornell Medical Center, New York City; Feb. 18, 2010, New England Journal of Medicine

 

Where do you get your chemotherapy?  I go to Sunnybrook Hospital.

 
Please keep us updated and I will keep looking.
 
Love,
Connie

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Cherseybear View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Cherseybear Quote  Post ReplyReply Direct Link To This Post Posted: Feb 20 2010 at 4:22pm
Hi Connie,
 
Thanks for the article, I think i'll print it and take it with me next week when I see my doc.
 
I actually am on weekly Cisplatin.  Three weeks on and then one week off, that's my cycle.  I had a transfusion early on (right after I was restaged) for RBC, WBC and Platelets.  I think I probably need  everything again, cause the platelets were the issue last week but the WBC, specifically neutrophils, were the issue the week before.  The hemoglobin count only got up to 100 after the transfusion and sits now at about 95, so I'm feeling a little weary, I think normal is 115 to 140.
 
I get my treatment at Sunnybrook too.  Maybe we should plan to meet sometime if our appointments cross?
 
Cheryl xo
Dx. 03/07/08 - Masectomy & node dissection 22/07/08. IDC, 8/14 positive nodes, Grade 3/Stage 3C. Tx - 4DD AC then 4DD Taxol. Avastin - Beatrice Study. 30 Rads. Liver Mets - November '09.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Donna Z Quote  Post ReplyReply Direct Link To This Post Posted: Feb 20 2010 at 5:00pm
Hi Cheryl. We are putting a pt on a chemo drug that suppresses the bone marrow and they already have low platelets to start with. So we have been searching for approval for this. I do not know if we will get it but we are in the process of trying. I will check on Mon. as we just received a package from Amgen and this is in Canada. Or this may be something you can run by your oncologist as well. If we can get coverage we also give epogen (stimulate red blood cells) and neupogen (stimulate neutriphils) and monitor closely trying to get them on as low a dose as possible to keep their blood levels in the safe zone. They are typically on treatment for one year. We do have to jump through all kinds of hoops to get coverage so I do not know what Ontario will cover regarding these. With many of the private plans like Blue Cross we have had very good success getting it paid for. So if you have private coverage?? Or maybe your onc will look at other chemos that are not as hard on those counts. Just sending this along on the remote chance it could be helpful.
Donna

U.S. FDA approves Amgen's blood platelet booster

WASHINGTON
Fri Aug 22, 2008 5:41pm EDT

WASHINGTON (Reuters) - Amgen Inc drug Nplate is safe and effective for treating a rare clotting disorder that can cause dangerous bleeding, the Food and Drug Administration said on Friday in approving the product for U.S. sales.

HEALTH  |  STOCKS  |  REGULATORY NEWS

The injectable drug helps stimulate bone marrow into producing blood platelets in patients with chronic immune thrombocytopenic purpura (ITP), the FDA said. The agency approved its use for patients only after other available treatments fail to help.

"This product is important in that it offers a new approach to the treatment of patients with an uncommon blood disorder who are often very ill," said Dr. Janet Woodcock, head of the FDA's Center for Drug Evaluation and Research.

Other approved ITP treatments include steroids, immune-suppressing drugs or surgery to remove the spleen.

"Until now there have been limited FDA-approved treatments available to patients suffering from chronic adult ITP, and the treatment options were often unsuccessful for long-term use," Amgen said in a statement.

The total cost of care for Nplate patients is expected to be "less than or comparable to the total costs of care with standard treatment regimens," the Thousand Oaks, California-based biotech company said.

Nplate was approved based on two studies of 125 patients who took the drug for six months, according to the FDA. Doctors who want to prescribe Nplate will have to enroll themselves and their patients into a special registry that will track long-term safety.

Those who received Nplate showed "significantly higher platelet counts and maintained those higher counts compared to those who did not receive the drug," the FDA said.

Patients who still had their spleen fared better than those who did not, it added.

ITP occurs when the immune system destroys platelet cells that help the blood clot and low platelet levels can trigger life-threatening bleeding. Patients with the condition are also more likely to experience bruising.

Nplate, also known as romiplostim, is not expected to be a big seller and also faces competition. About 60,000 U.S. adults have chronic ITP, Amgen has said.

Some analysts expect it to earn anywhere from $66 million to $117 million in 2009 sales and peak around $200 million -- small compared with Amgen's 2007 revenue of $14.7 billion.

GlaxoSmithKline Plc's rival drug, Promacta, or eltrombopag, faces an FDA approval decision by September 19.

Amgen's shares were largely unaffected by the FDA's decision, in part because the ruling had initially been expected in July before the agency postponed it.

Analysts have instead been buoyed by hopes for its experimental osteoporosis drug called denosumab, which is still in development.

"We are encouraged by the approval, but note that the small patient market for this drug will result in a modest contribution to the company's revenues," William Blair & Co analysts said in a research note.

"We continue to believe that the most meaningful revenue addition for Amgen will be pending approval of denosumab in osteoporosis," they wrote.

Both Amgen and Glaxo shares closed up less than 1 percent on the Nasdaq and the New York Stock Exchange, respectively.

The company said it was seeking additional approval for Nplate in Europe, Canada and Switzerland. Australian authorities approved the drug last month.

Dx 03/09 TN, Stg 2a, gr 3, 1.7 cm Taxol X 12, FAC X 4, segmental mastec Sept 10/09,
1 pos/29, from Canada, Treatment MDAnderson, rads X 30 started Oct 29/09. Zometa start Nov 24/09
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Post Options Post Options   Thanks (0) Thanks(0)   Quote kidzrn Quote  Post ReplyReply Direct Link To This Post Posted: Feb 20 2010 at 10:15pm
I was going to suggest  changing treatment to every 3 weeks like they did me. I was on carboplatin, which I think is a little friendlier to the platelets than cisplatin but my plts wouldn't tolerate weekly x 3 then week off....also with taxol and avastin mixed in ....Makes sense since the lifecycle of a platelet is 7-10 days....Doesn't seem you have enough time to rebuild......or the Nplate sounds interesting....haven't tried that...Hope things turn around soon for you!!! Christi 
christi
2006,TNBC,Gr3 dbl mast, 4AC/4T {NED 4/07}, Lung Met 4/08, Carbo, Avastin, Taxol/Taxotere (CAT)x4, Lung Surgery 9/08, 4 CAT, then Avastin every 3 wks...NED 2/09, 2/10, 6/10, 10/10 Scans 4/11
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Wendy2 Quote  Post ReplyReply Direct Link To This Post Posted: Feb 21 2010 at 10:21am
Kristi
 
Jst tryint to reconnect. Wendy here.
 
How are you?
 
dx 3/06 TN, taxotere/cytoxin x4; radiation x 40; mets. to lungs, lymph nodes 3/08 - to begin chemo 4/29/08 Abx/Avas., 9/08 Avastin maintenance, 1/09 - off meds to see if Avastin causing headaches
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Wendy2 Quote  Post ReplyReply Direct Link To This Post Posted: Feb 21 2010 at 10:23am
I am in a trial BSI-201 and my platelets and red blood just can't keep up. I'm always getting platelets and blood transfusion. cutting back on my carboplatin.  It is discouraging not to get chemo! I've asked about everything  - of what I could do to help this, doesn't seem to be an answer.
dx 3/06 TN, taxotere/cytoxin x4; radiation x 40; mets. to lungs, lymph nodes 3/08 - to begin chemo 4/29/08 Abx/Avas., 9/08 Avastin maintenance, 1/09 - off meds to see if Avastin causing headaches
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Post Options Post Options   Thanks (0) Thanks(0)   Quote dmwolf Quote  Post ReplyReply Direct Link To This Post Posted: Feb 21 2010 at 11:23am
Hi, Wendy.  It's good to see you here.  How are you, other than the tired platelets?    Are you on the PARPinh, and if so, how is it doing?
Love,
Denise
DX 2/08@43 stg II IDC; gr2,0 nodes. Neoadj chemo, first ACx2 (fail) then CarboTaxotereX6(better). Lump, Rads done 11/08; Clodronate. False alarm queen: PetCT lung & TM marker. NED. PBM w/recon 9/10.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote harbin Quote  Post ReplyReply Direct Link To This Post Posted: Mar 14 2010 at 2:13am

Hi christi,

I read your post and it looks like have been treated with both Cisplatin and Carboplatin. I wonder if you can share your experience on each of them. My doctor suggested me to take either one of them (prefer to Cisplatin), but I am having hard time to decide which one to take.  I would like to hear from you.
Thanks,
Harbin
4/08 dx IDC,stg2,neg. nodes,4xAC,8xTexol& Avastin,BRCA-
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