Waiting on chemo…platelets still going down

[Sipj]

We’ve been waiting to do cabazitaxal now for three weeks due to low platelets. They continue to drop weekly and daily. As of Thursday they were at 31. Held off on chemo to find out bone marrow biopsy results done same day. Should get results Monday.

MO says if it is cancer in the bone marrow, recommends proceeding with chemo to try to kill some cancer that is affecting his marrow. If it’s not cancer??

In the meantime I am worried about what is happening to his platelets. Doctor says they won’t do a transfusion until it reaches 10-20, but without doing labs everyday how are we to know? In two days it dropped 6 points…

He has no energy, bruises easily, swollen/water retention in one leg, and every other side effect from MCRPC.

Hard to hang on to hope.

Any thoughts?

[EdBacon]

It's likely that bone marrow invasion from the cancer is causing this.

It doesn't make any sense to me that you would wait to do a transfusion when the low platelet count is what's preventing you from doing chemotherapy.

I'd get another opinion or go somewhere else to see if you can get a transfusion. You have nothing to lose.

I can see doing a biopsy, but in the meantime they should be treating the problem.

[Sipj in reply to EdBacon]

that is what I was wondering and spoke to the doctor specifically about that. I hate the waiting game, every day is a huge factor at this point.

I get the second opinion but I can imagine it taking weeks to get into another doctor. He doesn’t have weeks.

[EdBacon in reply to Sipj]

If they find it's cancer from the biopsy, are they going to give him a transfusion then, or does he still have to wait until it drops to 10-20? According to the prescribing labels, you need 100,000 cells per cubic mm to take Docetaxel or Cabazitaxel.

[Sipj in reply to EdBacon]

Doctor says if biopsy is positive they’ll do chemo. If it drops more they’ll do transfusion. Worries me that they’ll do the chemo with such low platelets but maybe he’s expecting to do chemo, monitor and as soon as it gets that low do transfusion.

[EdBacon in reply to Sipj]

My understanding is that if you keep the platelets above 10K, the risk is fairly low. Of course chemo might bring them down so definitely would need monitoring I would think. I can't see starting chemo at 30K though, when the prescribing label says 100K. Doesn't seem right to me, but doctors know more than I do.

[Brianne07]

Good morning from Sydney Australia..When on chemo and my white blood cells were going down they gave me a self injector called Pegfilgrastim or the other name may have been RISTEMPAV which makes more neutrophils..Even not on chemo they probably would prescribe it

Regards Brian

[Sipj in reply to Brianne07]

yes, during his last chemo rounds last year with docetaxal he did do that but it’s his platelet count that is low this time. And they do plan to do the Nuelasta injections again.

[Bspouse]

My husband had to delay chemo due to falling platelets although levels were not below 40. MSK suggested to our oncologist to try 4 days of mega doses of dexamethasone ( 40 mg a day!) Supposedly to jump start the platelet production. Husband also has bone mets and was diagnosed with prostate cancer from a bone biopsy.

I dont know if I can recommend this regimen because husband had severe stomach issues by the 3rd day and ended up getting hospitalized with c-diff. His platelets did start to rise though.

Another thought - did he receive Ketoconazole to try and lower his PSA ? I read that it occasionally causes a severe drop in platelets. We dont know if Ketoconazole caused the drop for my husband, but his platelet count was OK before starting it and eventually went back up to 140 after stopping it. ( but he also had the dexamethasone so hard to tell exactly what worked).

Good luck to you both. I hope you are able to get the transfusion and get started with the chemo. I know the waiting and not knowing how he will respond is difficult.