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Anyone skip Neulasta?

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HoneyBee View Drop Down
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    Posted: Aug 29 2016 at 9:59pm
The side effects worry me a bit. I've now heard of two people developing leukemia post treatment. Did you take it or skip it with AC?
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Warrior31 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Warrior31 Quote  Post ReplyReply Direct Link To This Post Posted: Aug 30 2016 at 3:38am
Hi HoneyBee,

I took Neupogen when I was on AC. I couldn'T have done AC otherwise since my neutrophils were extremely low. Even with Neupogen I had my last AC treatment with my neutros less than 0.5 which was the minimum required. The side effects from Neupogen were not that bad, some bone pain from time to time and maybe light headaches. 

I'm curious to know about these stories of developing leukemia after Neulasta. Were these people using Neulasta along with chemo or other treatment, and if so, how can we tell that leukemia was due to Neulasta and not something else?

Overall I think you can ask you MO is he'd agree to give you one AC cycle without the Neulasta and then see from there. If your neutrophil counts come back to normal on their own, well there might not be a need for Neulasta.

Good luck!
Dx at 31 yrs-old 06/03/15; left IDC 1.6 cm; Chemo 28/04/15: 12 weekly Taxol then 4 AC; Lx with SNB 24/11/15; no PCR: 3 mm residual; 20 Rads 20/01-17/02/16. 8 cycles of Capecitabine started 04/01/16.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Tulips Quote  Post ReplyReply Direct Link To This Post Posted: Aug 30 2016 at 11:59am
Hi Honeybee,

Ditto to everything Warrior said!  Also, I clearly remember signing off on my chemo having risks of secondary leukemia, and I don't recall that for Neulasta.  Perhaps there are studies that follow women who had chemo only vs. those with chemo and Neulasta, that would indicate that Neulasta caused long-term issues?  But if not, I would more likely chalk the leukemia up to the chemotherapy as the cause.  I also tolerated both Neupogen (during Taxol) and Neulasta (during AC) very well, and had big issues with my WBC counts without them, so they were imperative for me.  Good luck!!
Dx April 2015 IDC TN 2.2 cm, Grade 3, Chemo started May 2015: Taxol/Carbo then AC, Lx with SNB Nov 2015, 33 Rad Dec 2015-Feb 2016. 6 months Capecitabine starting March 2016
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Post Options Post Options   Thanks (0) Thanks(0)   Quote gordon15 Quote  Post ReplyReply Direct Link To This Post Posted: Aug 30 2016 at 5:53pm
Nuelasta is actually used in leukemia patients, nowhere have I read it actually causes it. Here's some info on it

http://news.cancerconnect.com/a-single-dose-of-neulasta-is-as-effective-as-16-doses-of-neupogen-in-the-management-of-patients-with-leukemia/

Neulasta® and Neupogen® are agents that stimulate the production of immune cells in the body. The action of Neulasta® and Neupogen® reduces or even completely prevents the development of chemotherapy induced neutropenia and its associated complications in patients undergoing chemotherapy. Neulasta® has been designed so that only one injection is given per chemotherapy cycle compared to the daily injections required for Neupogen® administration






Edited by gordon15 - Aug 31 2016 at 8:30am
wife: IDC/Lobular Stage2B 2008 lumpectomy/TAC+rads
TNBC Stage 3A/w/metaplastic/squamous Nov2015 Carboplatin-Gemzar chemo/masectomy Taxolchemo+rads 4-16
PET scan stable 9-2016/ 1-2017
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Kellyless Quote  Post ReplyReply Direct Link To This Post Posted: Aug 30 2016 at 9:55pm
You can't so dose dense AC without it, with it I just squeaked by. You'll have to do every 21 days instead of 14 would be my bet.
IDC, 2.2 cm, Stage IIb,lumpectomy 1/30/09 ACx4,Tx4 36 rads
6/1/16 Local recurrence same breast, same spot 1.8cm Carb.4x every 3 wks, Taxol 12x once wk. Dbl Mast. PCR!! Reconstruction fail, NED!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Katdoll Quote  Post ReplyReply Direct Link To This Post Posted: Aug 31 2016 at 1:31am
My doctor told me it is the chemo that can cause leukemia, although it's rare. But if your doctor has told you neulasta can cause leukemia, I'm sure your doctor is right. A few years ago, I heard Group Health does not administer neulasta routinely with AC or other chemo - they only administer if you have indicia of actual infection vulnerability such as low white blood count, or have actually had a serious infection. But they may have changed that by now.
Tested positive for BRCA1 mutation (187delAG) in 4/09 @ age 44; BSO 9/09; diagnosed w/TNBC in 10/09; 1 cm Stage 1 TNBC IDC, grade 3 + 1.5 cm DCIS; BMX 11/09, nodes clear; chemo (AC/T).
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Aug 31 2016 at 8:32am
I agree with the others too.  One of the side effects of chemo, although small, is leukemia.  You'll want the neulasta shot to keep your white blood count up.  Otherwise if your wbc is too low, treatment may be delayed because your body wouldn't be able to fight off any infections.  

Here's a link to more information on Neulasta:


For some people, the biggest side effect of the neulasta shot is bone pain.  Many have found relief or some relief by taking Claritin (just plain Claritin, not the Claritin D) the day of the shot and several days afterwards.  

I copied this post from another thread:

[QUOTE=Lee21]This is what I have been able to find regarding the use of growth factors (Neulasta and Neupogen are formulations of G-CSF, granulocyte colony stimulating factor) in prevention of febrile neutropenia (fever due to low neutrophil count) (ASCO 2012):
http://jco.ascopubs.org/content/30/14/1715.long
Pg 3 Table 1 item #5
Don’t use white cell stimulating factors for primary prevention of febrile neutropenia for patients with less than 20% risk for this complication.
● ASCO guidelines recommend using white cell stimulating factors when the risk of febrile neutropenia, secondary to a recommended chemotherapy regimen, is approximately 20% and equally effective treatment programs that do not require white cell stimulating factors are unavailable. 
● Exceptions should be made when using regimens that have a lower chance of causing febrile neutropenia if it is determined that the patient is at high risk for this complication (as a result of age, medical history, or disease characteristics).

Generally, this recommendation translates to growth factor support in the setting of dose dense chemotherapy regimen (chemo given every 2 weeks); G-CSF also seems to be provided regularly when a patient is getting TAC even though it is on a 3 week regimen. The oncologist has discretion determining who needs it based on age, co-morbidities, and other factors.

G-CSF usage is not without risk:
http://jnci.oxfordjournals.org/content/99/3/196.long

Acute myeloid leukemia or myelodysplastic syndrome following use of granulocyte colony-stimulating factors during breast cancer adjuvant chemotherapy

I've asked this of two prominent oncologists and they think the jury is still out.

DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote MLindaG Quote  Post ReplyReply Direct Link To This Post Posted: Sep 06 2016 at 10:45pm
I did not do neulasta shots but I had chemo every three weeks x 4 treatments. (Not every two weeks)   My white count never went down too low.  I'm not sure why some areas of the country do the every two weeks but here in Pittsburgh every three weeks is the norm.  I then did 12 weekly taxol.  I started with a 3 1/2 cm lump.......node involvement in chest wall as well as three nodes under the arm.  I did achieve a PCR. 
Dx TNBC 6/12; age 59; Stage 3, Grade 3; 3.5 cm, 3/10 nodes + chest wall nodes; A/C x4, T x 12 completed 12/12 with PCR, 2/13/13 lump; IMRT Rads x 33 completed 5/22/13 BRCA 1 negative.
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