Reversal of neutrophyls? News from Delhi

[Guest guest]

In a message dated 7/30/2008 9:14:59 A.M. Eastern Standard Time, naturalway@... writes:

Hello Everyone

Thank you for every one who replied to my question on higher doses of Rituximab.

I am sorry ihave been unable to reply individually.

Besides my wifes problem , last month was pretty hectic as my mother who is 85 has been diagnosed with Alzheimers.

So it was almost like the last straw. As it is I have had to look after my wife now this news was really depressing.

We have always lived together with my grand parents,parents ,us and our children.

Gradually from the 8 people of 4 generations living amicably together, we are down to my mother me and my wife living together. The two children as it happens have flown the coop. My father got bladder cancer and passed away. I suppose the loneliness eventually got to my mother. Even though we live together I suppose its not the same as having him around for her.

Anyway thats life I suppose.

As I discuss with my wife, we have been there for our parents but then however well meaning and helpful our children are, which they have both been , we eventuallyhave to fend for ourselves as the times have changed and nowadays the children have so many other obligations and pressures which we never had while they were growing up.

Our son is in New York and daughter married and with a 2 year old so has her hands full with a second one on the way. Fortunately she lives 30 minutes away so can come over .

Even in India the joint family system is facing stress and partly disintegrating as children move because of jobs and other compulsions.

any way, to get down to the point of this mail,

My wife's 5th cycle went off well with the higher dose of Rituximab at 500 mg /m^2 insteaqd of the 375 mg /m^2.

Her counts are as follows:

Before Start of cycle 5:2.7.208 : 2 days before starting cycle 5 :TLC 11,900, HB 10.1, RBC 2.83, Platelets 1,40,000, Lymphocytes 82%Neutrophyls 10%, Eos 6, Mono 2% PCV 30.8, MCV 109, MCH 35.8, MCHC 33.9.7.08 day 6TLC 7,300, HB 10.1, RBC 2.88, Platelets 1,50,000, Lymphocytes 64% ,Neutrophyls 26%, Eos 9%, Mono 1% PCV 32.2, MCV 112, MCH 35.2, MCHC 31.528.7.08 day 25TLC 3,600, HB 11, RBC 3.01, Platelets 1,20,000, Lymphocytes 70% ,Neutrophyls 13%, Eos 13%, Mono 3% PCV 32.2, MCV 112, MCH 35.2, MCHC 31.5

She was due for the next cycle on 1.8.08 but the doctor has put it on hold due to the fact that her ANC isnow below 500.

So he had advised 3 days of Neupogen shots and then to wait 24 hours and start Cycle 6 on 4.4.08 .

Today she had the pentamidine inhalation which went off well as usual - thanks to all the inputs from the list, and prof Catovsky's advice. She is given premeds of Salbutamol and Butacort as inhalations then the pentamidine is mixed with 2.5 ml salbutamol and given through the special Rspigard II nebuliser with an oxygen line at a pressure of 10.

The worrying thing is that the neutrophyls and the lymphocytres have not reversed.

In her last RF cycle in 2002 this happenned by cycle 3.

This time she has been given the first two cycles of FC only as her TLC was 3,90,000 before cycle 1.

The doctor here was extremely negative about the oral fludara and oral cyclophosphamide.Said it is not advisable , the IV is better - at least we know all the drug has gone in where its needed according to him.

Any way cycle 3 to 5 were RFC as IV. She had the Bard port installed and the veins were no longer a problem.

The blood transfusions also went like a dream through the port.

Fortunately her HB has stabilised after cycle 4 and she has not needed further transfusions.

We have been giving her lots of greens and beetroot and chicken livers . For the platelets we were giving her foods high in Vitamin K which seem to have helped.

The doctor here says it seems to be going well except that he seems to be unhappy that the neutrophyls and lymphocytes have not reversed.

In fact he suggested that she was not responding and maybe she should go in for a transplant.

I told him not to discuss it with her at the moment as she needs to be positive at the moment and not think of these options.

Professor Catovsky says today in his mail that she seems to be doing well and we should do cycle 6 then 1 month later do a bone marrow to asssess the response.

She still has to have 2 more cycles of Rituximab after that to complete 6 cycles of Rituximab.

He says we will then decide if in the 7th cycle which is only Rituximab as scheduled now do we need to add Fludarabine and Cyclophosphamide again.

He was last time suggesting that maybe a 7th of RFC instead of just R may be more benificial to get a CR.

Has anyone had these problems of the Neutrophyls not reversing till cycle 6 and if so did they reverse after that?

Has any one had more than 6 cycles of RFC?

Any inputs as always will be extremely welcome.

Now we are starting on the neupogen tomorrow for 3 days then will get a blood test on sunday before starting the next cycle on Monday the 4th August.

Thank you for your time.

When is Dr. Hamblin going to be answering questions on the list?

Be well

from Delhi

- Dr. Furman is our medical advisor, not Dr. Hamblin - I'm sure he will pick up on your e-mail - Get fantasy football with free live scoring. Sign up for FanHouse Fantasy Football today.

[Guest guest]

Hello Everyone

Thank you for every one who replied to my question on higher doses of Rituximab.

I am sorry ihave been unable to reply individually.

Besides my wifes problem , last month was pretty hectic as my mother who is 85 has been diagnosed with Alzheimers.

So it was almost like the last straw. As it is I have had to look after my wife now this news was really depressing.

We have always lived together with my grand parents,parents ,us and our children.

Gradually from the 8 people of 4 generations living amicably together, we are down to my mother me and my wife living together. The two children as it happens have flown the coop. My father got bladder cancer and passed away. I suppose the loneliness eventually got to my mother. Even though we live together I suppose its not the same as having him around for her.

Anyway thats life I suppose.

As I discuss with my wife, we have been there for our parents but then however well meaning and helpful our children are, which they have both been , we eventuallyhave to fend for ourselves as the times have changed and nowadays the children have so many other obligations and pressures which we never had while they were growing up.

Our son is in New York and daughter married and with a 2 year old so has her hands full with a second one on the way. Fortunately she lives 30 minutes away so can come over .

Even in India the joint family system is facing stress and partly disintegrating as children move because of jobs and other compulsions.

any way, to get down to the point of this mail,

My wife's 5th cycle went off well with the higher dose of Rituximab at 500 mg /m^2 insteaqd of the 375 mg /m^2.

Her counts are as follows:

Before Start of cycle 5:2.7.208 : 2 days before starting cycle 5 :TLC 11,900, HB 10.1, RBC 2.83, Platelets 1,40,000, Lymphocytes 82%Neutrophyls 10%, Eos 6, Mono 2% PCV 30.8, MCV 109, MCH 35.8, MCHC 33.9.7.08 day 6TLC 7,300, HB 10.1, RBC 2.88, Platelets 1,50,000, Lymphocytes 64% ,Neutrophyls 26%, Eos 9%, Mono 1% PCV 32.2, MCV 112, MCH 35.2, MCHC 31.528.7.08 day 25TLC 3,600, HB 11, RBC 3.01, Platelets 1,20,000, Lymphocytes 70% ,Neutrophyls 13%, Eos 13%, Mono 3% PCV 32.2, MCV 112, MCH 35.2, MCHC 31.5

She was due for the next cycle on 1.8.08 but the doctor has put it on hold due to the fact that her ANC isnow below 500.

So he had advised 3 days of Neupogen shots and then to wait 24 hours and start Cycle 6 on 4.4.08 .

Today she had the pentamidine inhalation which went off well as usual - thanks to all the inputs from the list, and prof Catovsky's advice. She is given premeds of Salbutamol and Butacort as inhalations then the pentamidine is mixed with 2.5 ml salbutamol and given through the special Rspigard II nebuliser with an oxygen line at a pressure of 10.

The worrying thing is that the neutrophyls and the lymphocytres have not reversed.

In her last RF cycle in 2002 this happenned by cycle 3.

This time she has been given the first two cycles of FC only as her TLC was 3,90,000 before cycle 1.

The doctor here was extremely negative about the oral fludara and oral cyclophosphamide.Said it is not advisable , the IV is better - at least we know all the drug has gone in where its needed according to him.

Any way cycle 3 to 5 were RFC as IV. She had the Bard port installed and the veins were no longer a problem.

The blood transfusions also went like a dream through the port.

Fortunately her HB has stabilised after cycle 4 and she has not needed further transfusions.

We have been giving her lots of greens and beetroot and chicken livers . For the platelets we were giving her foods high in Vitamin K which seem to have helped.

The doctor here says it seems to be going well except that he seems to be unhappy that the neutrophyls and lymphocytes have not reversed.

In fact he suggested that she was not responding and maybe she should go in for a transplant.

I told him not to discuss it with her at the moment as she needs to be positive at the moment and not think of these options.

Professor Catovsky says today in his mail that she seems to be doing well and we should do cycle 6 then 1 month later do a bone marrow to asssess the response.

She still has to have 2 more cycles of Rituximab after that to complete 6 cycles of Rituximab.

He says we will then decide if in the 7th cycle which is only Rituximab as scheduled now do we need to add Fludarabine and Cyclophosphamide again.

He was last time suggesting that maybe a 7th of RFC instead of just R may be more benificial to get a CR.

Has anyone had these problems of the Neutrophyls not reversing till cycle 6 and if so did they reverse after that?

Has any one had more than 6 cycles of RFC?

Any inputs as always will be extremely welcome.

Now we are starting on the neupogen tomorrow for 3 days then will get a blood test on sunday before starting the next cycle on Monday the 4th August.

Thank you for your time.

When is Dr. Hamblin going to be answering questions on the list?

Be well

from Delhi