What would you do?

[Arisgram]

So last week I was admitted to the hospital for 4 days with sever cellulitis in my lymphedematic arm. I was given infusions of Vancomycin, Zocyn and Rocephin. On the last day, I was given Dalvance so that I would not have to have a PIC line. The half-life of Dalvance is 14.4 days. Upon admission, my ANC was 770, and I was on day 6 of 125mg Ibrance, I refused labs at discharge because of the condition of my one good vein.

My oncologist requested I have a CBC with diff at one week which I did yesterday. My ANC is down to 450, and I am on day 13 of Ibrance. I faxed the results to him, and he has instructed me to continue on the Ibrance through the course as usual. Doesn't that seem really risky? My neutrophils could easily get down into the 3.0 range at this rate. Typically, my nadir is usually day 21 or day 1 of the off week. I work full time and have no way to isolate myself, nor do I want to.

I am thinking I will take the week off, finish the course and then take another week off. What would you do?

Andi

[Lordmandy]

I have no experience with lymphedema or those drugs that you mentioned, other than Ibrance 125 mg. My doctor did tell me that in the five years that Ibrance has been approved, they have learned that a lower ANC from Ibrance is not like having neutropenia from IV chemo and is not as risky. I don’t think they know why, but they have evidence that that is true. I don’t know your work situation nor the affects of your other drugs, so I have nothing to offer other than that information which, through my own experience, seems to be true.

[Arisgram in reply to Lordmandy]

Thank you. I have read that, and I have tried to find something in the literature. My ANC is typically in the 600 to 700 range. 300-400 scares me a little....especially with flu raging all around.

Thank you for your response.

Andi

[Lordmandy in reply to Arisgram]

You make a very good point there. My ANC is 6 to 700 also. I have been off my Ibrance since the last week of December, because Radiation also brings down your white count. I expect to start back on Monday after seven weeks

[Lordmandy]

I also want to add that I am sorry you’re having to deal with the lymphedema. I understand it could be quite a struggle.

[Arisgram in reply to Lordmandy]

Thank you. I've had it for so long, I don't think about it much anymore. A cellulitis served as a great reminder!

I hope you are doing well after your radiation. I had stereotactic therapy the first of December, and was not prepared for the butt kicking it gave me!

All the best!

Andi

[Lordmandy in reply to Arisgram]

I definitely had pain between my shoulder blades for a few days. The I MRT on my lumbar spine has slightly affected my colon, but nothing like conventional radiation would have. I have had some major diarrhea and have lost 7 pounds. I have a little nausea and feel weak, but I’m all done now and expect to feel better soon! Back on my Ibrance beginning Monday. I hope you are feeling better soon too. Let’s stay in touch. You’ll be in my prayers.

[Arisgram]

Thank you, Sandra. The blood culture was inconclusive which was of no surprise to anyone. They treated me for both MRSA and strep, and it seems as if the infection has cleared. I had not really considered the protection the Dalvance would provide as my count dropped.

I checked my ANC this morning, and I'm down to 410. I feel like hell.

I think I'm just going to take the next couple of days off. I'll start back on my 21-day course, after my count tops 700.

As always, thank you for your input. And you are such a valuable member of this team. I know that not only your dealing with your disease but that of your husband's as well. Thank you for taking the time to help us! I will be thinking of you during your upcoming scan.

Andi

[Lordmandy in reply to Arisgram]

I think she’s right. 410 is low, and you need to rest up anyway.