Pegasus and Low Neutrophils

[DougyW]

I stated taking 45mg of Pegy weekly in January. My Neutrophils were seen to be dropping in March and by late April were below 1 so I was switched to bi-weekly injections. After a further 4 weeks and a phlebotomy end of April my Neutrophils have dropped further. I'm pondering the options. The obvious is to stop taking Pegy and switch to Hydroxy, which I'd rather not. Ruxo is another option which is less common in the UK. Is a short holiday and reset an option worth considering?

Any thoughts from you would be gratefully received. Thanks

[hunter5582]

Sorry to hear about the neutropenia. Unfortunately, this can happen with cytoreductive medications. You are correct to think that one option would be to take a break from the Pegasys then rechallenge to see if it works better. You would also have to option to try the other interferon, Besremi. You may respond better to Besremi. It would also be an option to try Jakavi if you are so inclined.

It would be best to review all of your options with a MPN Specialist to get the best case-specific advices.

Please let us know how you get on.

[DougyW in reply to hunter5582]

Many thanks for your time again Hunter.

[Manouche]

Another option would be to have a lower dose of weekly Pegasys injection (30mcg) together with daily hydroxy tablets.

[EPguy]

Your current dose is a weekly equiv of 22.5, very low. It seems the reduced dose does not hold your HCT enough while it still reduces your Neut too far. So further dose reductions are likely not productive. Did the higher dose hold the HCT? Incidentally we see here that various members still require phleb while on IFN, its HCT benefit seems especially variable in our small sample.

IFN is known for sometimes excess WBC reductions, for many this is the dose limiting effect as it was for me. (till a far larger effect happened)

As Hunter said, Bes could provide a different result, while both work in similar ways. Rux does not tend to lower WBC out of proportion to other counts although it can alter WBC function according to my MPN Dr.

[DougyW in reply to EPguy]

Thanks EP guy being English Bes is not on the books, I think. Will chat around it with my Haemologist but can feel Hydroxy on the way.

[lizzziep]

I’m in the UK and on Rux, Momelitinib is also now available on the NHS.

[DougyW]

Thanks all. My Haemologist has stopped my pegy for the next 4 weeks and asked for a battery if blood tests in 2 & 4 weeks time. It was a new person this time & he has questioned the need for drug treatment as I'm a fit 61 with only mild itchy skin as a symptom. I didn't mind going on IFN to try and reduce the longer term risks of progression however I'm also happy to be on asprin and infrequent venosection for the next 3 - 4 years. Wait and see for now. Avoid crowded spaces until the Neutrophils go above 1.