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prevention for neutropenia and possible infections
Mar 2, 2001

Dr. Dezube, I have already written you a couple of times and greatly appreciate your advice. On my first round of CHOP for NHLymphoma I started Neupogen on day 6, by day 10 I was in the hospital neutropenic. Two days later counts were back up to normal. Might it help if I start the neupogen earlier? Do you have a schedule you usually follow? Are there considerations to follow when one gets near that low point to help decrease the likelihood of infections? Do you give any prophylaxis drugs? Thanks for your help. Sincerely Dazed by the numbers

Response from Dr. Dezube

Dear dazed by the numbers, I typically start G-CSF (neupogen) on day three. By waiting until day 6, you can lose some "bang for the buck". So here is a typical schedule.

Let's assume you get your chemo on a Monday. I would recommend starting G-CSF on Wednesday and continuing until the following Monday (total of 5 days- W,Th, Fr, Sa, Su). Then I recheck the counts on that Monday. Unless they are sky high, I recommend continuing G-CSF for another five days (M, Tu, W, Th, Fr, Sa). My typical dose is 300 micrograms. This should do the trick; if not the dose of G-CSF can be increased to 480 micrograms, but typically patients don't need the higher dose.

You didn't mention what anti-retrovirals you are taking; it is important that you take a regimen which does not include AZT, since AZT does not go well with chemotherapy. In the event that you are on AZT, then I would recommend changing the AZT to d4T (after checking with your HIV provider). With these added days of G-CSF, you should not need any special antibiotic prophylaxis, other than PCP prophylaxis and whatever else you might need based on your CD4 count.

Lastly I should add for other readers, that not every one needs G-CSF. You certainly do, given that you've been in the hospital with neutropenia. GOOD LUCK. BD.

What are symptoms of lymphoma
declining CD4s with chemotherapy

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