Neutropenic fever

[leebeth]

My husband ended up in the hospital this past weekend with neutropenic fever. His temp spiked to 102.5, he was extremely fatigued, his WBC was 900, neutrophils 400, RBC 2.47, Hgb 7.6, Hct 23.3, and platelets 47. After a few days of IV antibiotics, he was discharged and feels great, no focal source of infection found

He had his 4th dose of carbazitaxel/carboplatin with Neulasta on 3/23, so this developed day 9 of his cycle.

He tolerated the first 3 great. One difference this time is that he had one fraction of palliative radiation to his right shoulder on 3/15, 8 days prior to his 4th chemo.

Do you think it is possible that the radiation was the culprit?

He is scheduled for #5 next week on 4/13. His MO had planned to reduce the dose but to proceed on the scheduled day.

My husband doesn’t want the dose reduced, as he has tolerated it without a blip other than this, and it’s working. If it’s possible that the cause was the radiation, that should no longer be a factor.

We would really appreciate your thoughts/input.

Thank you!

[George71]

I have read where the R/T can activate the immunotheray to see the cancer -- so it may be a good thing as long as the reaction is controlled... hopefully that is the case.

[leebeth in reply to George71]

Well, that would certainly be a silver lining!

[Tall_Allen]

Probably not due to the RT - the chemo itself (combined with the cancer) does a number on the bone marrow. Usually Neulasta will prevent febrile neutropenia. But it doesn't sound like Neulasta was enough. All of your husband's bloodwork is low, and his MO should really be making the call. Giving his bone marrow more time to recover or reducing the dose may help him survive another infection.

[leebeth in reply to Tall_Allen]

I value your opinion. Clearly I am searching for reasons as to why this time the Neulasta wasn’t enough, and the signs indicate overall marrow suppression. I am sure you are right and the dose reduction is what he needs. Absolutely he will defer to his MO, but my husband was hoping the one fraction could have been a direct cause. Wishful thinking! Thank you for the clarity.

[Dastardly]

I had a touch of Neutropenic Sepsis after my 2nd infusion of Docetaxel and spent a few days in hospital. I was then prescribed Filgrastim which I had to self inject for the first 10 days after each infusion. Sounds worse than it was. The needle was very thin, and I had an abundance of subcutaneous fat. It did the job though, and I finished my 6 cycles without any further episodes.

[leebeth in reply to Dastardly]

When my husband was on docetaxel, he did not need growth factor support at all. On his current cocktail of carbazitaxel /carboplatin, he has had the Neulasta Onpro (pegfilgrastim) auto-injector with each dose. That’s similar to the filgrastim (Neupogen) that you received. The first 3 cycles, that was sufficient for him.

I have one friend with AML who receives both, and it will be interesting to see if the MO chooses to go that route. He did mention, in passing, that he might choose to add that.

My husband won’t have to give the injections himself, since he had the foresight to marry a nurse. 😊

I am glad that worked for you! This Onpro gadget is pretty nifty, but outrageously expensive. Luckily, insurance pays in full. It saves a trip back to the clinic for the Neulasta injection the following day.

[Dastardly in reply to leebeth]

Well done to your husband for having the good sense and foresight to marry a nurse. Hope his current treatment regime works well. Good luck and good health to you both.

[leebeth in reply to Dastardly]

Thank you! Same to you!

[Hidden]

He’s really in the heat of the battle right now! 🙏

[Hidden]

Good foresight Indeed! ❤️