Use of Neupogen (or similar) prior to minor surgery

Posted by rrivory @rrivory, Jul 30, 2021

Has anyone with MDS used Neupogen (filgrastim) or similar prior to minor surgery to reduce the risk of infection? My concern is that even a short term use could change the progression of my MDS for the worse. Right now I have not symptoms, am on watch and wait, and my surgery is elective (for now). My neutrohpils are 0.8.

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Hello @rrivory Welcome to Mayo Clinic Connect. We’re an online community forum where members come together to use our life experiences to help each other. We’re not medical professionals so we can’t diagnose but we can offer suggestions to help find answers.

0.8 is a moderately low neutrophil count so you know you’re already at a greater risk for infection. I can see your thought process behind using Neupogen or Neulasta. It would temporarily raise your white blood count. But I share your concern about any impact this might have on your MDS.

If this were me, I’d really be talking to my hematologist/oncologist about having the elective surgery and any premeds. You’d have to get his/her prescription for the Nulastin or Neupogen anyway. So for your peace of mind and a professional opinion, your doctor or NP is your best bet.
Have you discussed this with your hematologist?

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@loribmt

Hello @rrivory Welcome to Mayo Clinic Connect. We’re an online community forum where members come together to use our life experiences to help each other. We’re not medical professionals so we can’t diagnose but we can offer suggestions to help find answers.

0.8 is a moderately low neutrophil count so you know you’re already at a greater risk for infection. I can see your thought process behind using Neupogen or Neulasta. It would temporarily raise your white blood count. But I share your concern about any impact this might have on your MDS.

If this were me, I’d really be talking to my hematologist/oncologist about having the elective surgery and any premeds. You’d have to get his/her prescription for the Nulastin or Neupogen anyway. So for your peace of mind and a professional opinion, your doctor or NP is your best bet.
Have you discussed this with your hematologist?

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I have discussed this with my hematologist/oncologist. The problem is that I'm concerned about his comment that it "shouldn't" cause my MDS to progress. To me that means it still could. So I was reaching out to see if anyone else had done this to find out what their experience was. I'm walking a fine line between potentially progressing my MDS for a currently elective surgery and taking a chance that the surgery will become necessary at a time when it's even more dangerous to have.

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@rrivory

I have discussed this with my hematologist/oncologist. The problem is that I'm concerned about his comment that it "shouldn't" cause my MDS to progress. To me that means it still could. So I was reaching out to see if anyone else had done this to find out what their experience was. I'm walking a fine line between potentially progressing my MDS for a currently elective surgery and taking a chance that the surgery will become necessary at a time when it's even more dangerous to have.

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I can sure appreciate your concern in trying to make this decision. It’d be great if our bodies all worked the same and came with an instruction manual, wouldn’t it? I’m going through a similar situation right now as I’m tapering off a medication. We just don’t know what’s going to happen so it’s like you, that fine line… Always a step into the unknown.

What does your gut say about this? Would it be better to just have the surgery now, while you’re stronger and healthier?
Have you taken either Neupogen or Neulasta before?

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@loribmt

I can sure appreciate your concern in trying to make this decision. It’d be great if our bodies all worked the same and came with an instruction manual, wouldn’t it? I’m going through a similar situation right now as I’m tapering off a medication. We just don’t know what’s going to happen so it’s like you, that fine line… Always a step into the unknown.

What does your gut say about this? Would it be better to just have the surgery now, while you’re stronger and healthier?
Have you taken either Neupogen or Neulasta before?

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I've never taken it before – thankfully I haven't had to take any medications or treatments yet (diagnosed 7/2020). My gut says wait, but I don't know if that's just that fear of the unknown LOL. And your second question is exactly what I am struggling with! If it weren't for having to take the Neupogen, I would definitely be doing it now.

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@rrivory

I've never taken it before – thankfully I haven't had to take any medications or treatments yet (diagnosed 7/2020). My gut says wait, but I don't know if that's just that fear of the unknown LOL. And your second question is exactly what I am struggling with! If it weren't for having to take the Neupogen, I would definitely be doing it now.

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Do you remember the good old days when our big decisions were, “OH i have a coupon for Tide but I really like Gain…ugh..what should I do?” Now we have these life altering decisions about medications that can impact our already affected bone marrow. As my hematologist and are are used to joking…Life is a blast until you find them in your blood. 🙄

Ok well, let’s just talk this through. You’d go ahead with the elective surgery if you didn’t have to be on a medication to avoid an infection. Your gut is saying no to the drug, not to the surgery. By the very nature of your blood disease whenever you face this surgery, it will require special treatment.

As you know, with MDS, the body doesn’t make enough blood. In your case, neutrophils are lacking. They’re the infection fighters. As the disease progresses, it often requires transfusions or blood products to stay healthy. Nulastin or Neupogen can also be given to simulate bone marrow to produce more blood cells. So it’s not out of the ordinary for MDS patients to be given this product when they need a boost in their blood production. The Nulastin is a better way of doing it as it won’t run your ferritin level way up the way blood transfusions can.

From my experience with super low neutrophils, it’s my thought if you did opt for surgery, along with the blood boosting meds, you’d also likely be given heavy doses of antibiotics before and after surgery. Because your neutrophils levels are so low the antibiotics provide you within an artificial immune system to help you through as a precaution and to bolster your weakened immune system.

How major is the surgery? is it laparoscopic or a major surgery?
If your MDS progresses and the surgery become necessary instead of elective, does this become a greater risk to you? Will it become more complicated physically?
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I’m also just tossing in as an FYI. 😉 I’ve had Neulasta 3 times. One dose after each of hefty Chemo treatments for AML.
Neulasta is one injection only, after a chemo regimen is over, to boost the white blood count in people who have low neutrophils. It’s pricey! But once and done and should see you through surgery and recovery.
Neupogen is similar in its ability to raise the neutrophils but it is given over longer periods of time…and cost less.
I’ll tell you upfront if you get either of these treatments, have Claritin antihistamines in your house! (Not Claritin-D) You’ll want to take one the same day and continuing for at least 7-10 days after the dose. It’s a pretty common and recommended preemptive treatment to the bone pain which can happen with either of the medications.

REPLY
@loribmt

Do you remember the good old days when our big decisions were, “OH i have a coupon for Tide but I really like Gain…ugh..what should I do?” Now we have these life altering decisions about medications that can impact our already affected bone marrow. As my hematologist and are are used to joking…Life is a blast until you find them in your blood. 🙄

Ok well, let’s just talk this through. You’d go ahead with the elective surgery if you didn’t have to be on a medication to avoid an infection. Your gut is saying no to the drug, not to the surgery. By the very nature of your blood disease whenever you face this surgery, it will require special treatment.

As you know, with MDS, the body doesn’t make enough blood. In your case, neutrophils are lacking. They’re the infection fighters. As the disease progresses, it often requires transfusions or blood products to stay healthy. Nulastin or Neupogen can also be given to simulate bone marrow to produce more blood cells. So it’s not out of the ordinary for MDS patients to be given this product when they need a boost in their blood production. The Nulastin is a better way of doing it as it won’t run your ferritin level way up the way blood transfusions can.

From my experience with super low neutrophils, it’s my thought if you did opt for surgery, along with the blood boosting meds, you’d also likely be given heavy doses of antibiotics before and after surgery. Because your neutrophils levels are so low the antibiotics provide you within an artificial immune system to help you through as a precaution and to bolster your weakened immune system.

How major is the surgery? is it laparoscopic or a major surgery?
If your MDS progresses and the surgery become necessary instead of elective, does this become a greater risk to you? Will it become more complicated physically?
~~~~~~
I’m also just tossing in as an FYI. 😉 I’ve had Neulasta 3 times. One dose after each of hefty Chemo treatments for AML.
Neulasta is one injection only, after a chemo regimen is over, to boost the white blood count in people who have low neutrophils. It’s pricey! But once and done and should see you through surgery and recovery.
Neupogen is similar in its ability to raise the neutrophils but it is given over longer periods of time…and cost less.
I’ll tell you upfront if you get either of these treatments, have Claritin antihistamines in your house! (Not Claritin-D) You’ll want to take one the same day and continuing for at least 7-10 days after the dose. It’s a pretty common and recommended preemptive treatment to the bone pain which can happen with either of the medications.

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I love your little joke … I'm going to use that one 🙂

Thanks so much for your insight. I didn't understand the difference between Neulastin and Neupogen, although Neulastin is not one that my hem/onc had mentioned. There are way more of those GSFs than I knew!

The surgery would be open surgery, but still considered out-patient. After much discussion and prayer, where I'm at right now is that I am going to wait. There is still an outside chance that my ANC could sneak up to 1.0 where the dr would be comfortable without the medication (at which point I'd jump on the surgery). I will be extra careful with my hernia not to do things that could make it worse. If things change with the hernia in the next year or so, I'm guessing my ANC won't be so low that we couldn't do the GSF at that point and still do the surgery. If they are, the hernia will be the least of my worries LOL. I trust that the Lord has this under his control and will guide me in the right direction.

Oh – and thanks for the heads up on the Claratin! I will keep that in mind if I ever have to start on those treatments. It's interesting to me that the Claratin helps with bone pain. One more thing to learn about!

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@rrivory

I love your little joke … I'm going to use that one 🙂

Thanks so much for your insight. I didn't understand the difference between Neulastin and Neupogen, although Neulastin is not one that my hem/onc had mentioned. There are way more of those GSFs than I knew!

The surgery would be open surgery, but still considered out-patient. After much discussion and prayer, where I'm at right now is that I am going to wait. There is still an outside chance that my ANC could sneak up to 1.0 where the dr would be comfortable without the medication (at which point I'd jump on the surgery). I will be extra careful with my hernia not to do things that could make it worse. If things change with the hernia in the next year or so, I'm guessing my ANC won't be so low that we couldn't do the GSF at that point and still do the surgery. If they are, the hernia will be the least of my worries LOL. I trust that the Lord has this under his control and will guide me in the right direction.

Oh – and thanks for the heads up on the Claratin! I will keep that in mind if I ever have to start on those treatments. It's interesting to me that the Claratin helps with bone pain. One more thing to learn about!

Jump to this post

It really would be much less worry if you could wait and see if your absolute neutrophils could reach at least 1.0. You’re so close and it would significantly cut your infection risk. I remember during the midpoint of chemo when my count was super low. I needed a very small incision made for a quick procedure but my doctor wouldn’t allow it until my count was back to at least 1.0. Then they jumped right on it!!

So your idea of waiting and just being extra cautious is really a good call. Relying on your gut instinct and your spiritual advisor can never hurt. 😉

Regarding the Claritin for the bone pain when taking Neulasta or Neupogen. Not everyone has it happen. But it’s thought that the bone pain caused by Neulasta is due to the effect Neulasta has on histamine, which induces inflammation and swelling in the bone marrow and results in pain.
Claritin is an antihistamine that blocks histamine, so it decreases the amount of inflammation and swelling in the bone marrow, reducing the pain.
And I have to say it really works!! But hopefully you won’t need to take that.
How often do you get bloodwork done to evaluate your MDS?

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