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Neulasta vs Neupogen

Psjeepster's picture
Psjeepster
Posts: 63
Joined: Jun 2016

I asked the oncologist today if the Neulasta shots were working. Dad is still ending up in the hospital 7 days after every enfusion with a serious infection and neutropenia. 

I asked if Neupogen might be the better choice. Or what other options should we be considering. 

 

Does anyone have any advice, experiences or other options that you think might be helpful?

 

Max Former Hodg...
Posts: 3689
Joined: May 2012

Ps,

Neulasta and Neupogen are virtually identical drugs, and do the same thing. Both are 'colony activity stimulators,' and both stimulate the production of WBC inside the bone marrow.   Presumably they differ slightly in chemical composition.  I find them analogous to Prozac and Zoloft, which are used for deppression: Both are 'SSI Uptake Inhibitors,' or in other words both attempt to treat depression by slowing the absorption of seratonin, a brain chemical.  But they differ slightly in composition, and one will work better one one patient, the other drug better on a differing patient.  Reflux drugs also: most 'turn off' acid producing 'pumps' (glands)  in the stomach, but no two are identical.

Neither N nor N should be given until at least 24 hours after an infusion, but otherwise the administration is different: Neulasta is given in one (1) dose to last between infusions (or up to around 14 days in the newer form), whereas Neupogen is given daily.  Differing chemo combinations  differ dramatically in terms of what drugs are  given when within a cycle.  Some combinations give most or all drugs at one infusion (R-ABVD is like this), whereas others have the patient getting a chemo agent every few days, or even every day.  In terms of administration, Neupogen is easier to accomodiate the latter scenario. This may be what determines whether an oncologsit chooses one or the other.

As I mentioned, there are undoubtedly molecular differences in the two drugs, and these differences might cause one to work a bit better than the other in your father's particular case, but it is not immediatly obvious why this would be true.   

You wrote that you asked his oncologist about this. What did he reply ?

max

Psjeepster's picture
Psjeepster
Posts: 63
Joined: Jun 2016

When I first talked to the oncologist about this. I asked if the Neulasta was working because he was still getting sick 7 days after the infusion. I was told that his bone marrow was getting so sick that by the time the Neulasta started working it was too late. I got the impression that the only thing the Neulasta was doing was stopping his blood counts from going lower then they already were. 

So I said what about neupogen, or what other option do we have. The oncologist said she would make sure that his insurance will cover it and we would start him on neupogen. Then out the door she went. 

It just scares me. I feel like every time I mention something they just say OK and we do it. I don't understand why it seems like I am coming up with all the ideas.

I found out today that they had been giving Dad neupogen shots when he was in the hospital. His blood counts were going up but still very low. He has been out of the hospital for a week now. This means he has not had neupogen for a week. His blood counts have dropped again. I was told that his blood counts look good except for his neutrophils. Her words were the neutrophils dropped to almost nothingot and we don't know why.

The plan of action now is to delay chemo. Keep checking his blood counts. If his neutrophils do not improve they are going to biopsy his bone marrow. Until then we sit back and wait. 

 

He is doing really well right now. He feels good. Peg and j tube are gone now. He gained 8 lbs and food has flavor again. He just gets tired easily. 

 

 

 

Max Former Hodg...
Posts: 3689
Joined: May 2012

Ps,

These good days for your father are a blessing for you and him both.  You are his greatest blessing, it seems.

Neulasta is usually effective. But undoubtedly there are cases in which it is not.

max

Psjeepster's picture
Psjeepster
Posts: 63
Joined: Jun 2016

You are so right Max. The good days are priceless. 

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