Speculation about chemo-induced anemia (and possibly leukopenia as well)

[Becky]

There is probably a difference when looking at it via low red counts versus low white counts (and what is low in those white counts – ie: neutrophils, lymphocytes etc).


My thoughts on red counts fall into 2 schools. One is the fact that the makers of Procrit (in the product literature they had in 2004 which is when I had chemo) stated that in their own studies – they found a reduced survival statistic in cancer patients who used their product versus blood transfusion. Therefore, when all the data and posts here started talking about it, it was out there already – and by the manufacturer themselves in their own product insert. Because of reading that insert (that was laying around the cancer center), I always wanted to avoid having to use that product and worried about it because my natural red blood cell count (RBC) is low to begin with and continues to be. That, plus chemo plus my last menstrual cycle (where I bled like a pig for one month – I went out with a bang) scared me that I would need some RBC assistance. I ended up not to.

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But before I ended up not needing anything, I did a lot of research in case I did. I did find articles contrary to Procrit’s own literature. This data says that greatly upping RBC any way you can (and they touted Procrit) would enhance cancer survival because more red cells means more oxygenation of body tissues. Cancer survives best in a nonoxygen environment so – oxygen weakens cancer. Oxygenation weaking cancer is a probable fact (and probably also one of the many reasons why exercise reduces the recurrence rate of bc). That is all I want or can say about the red cell count aspect at this moment. I am sure some of you will comment and I can then think on this more. However, the horse is out of the barn in saying that red cell boosters are not necessarily good. But, I think if you really need them, you really need them. They just should not be used willy-nilly.

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White blood cell (WBC) boosters are a different story. Although preliminary data says that they too are not good (to include G-CSF (Neulasta and Neupogen) and GM-CSF (Leukine)), the benefit of dense dose chemo for bc (every 2 weeks for AC followed by taxol) versus the regular dosing (every three weeks) is great (especially for Her2+ and triple negative women). There is a 38% survival benefit for dense dose overall (including all pathologies of which most are plain old ER+/PR+ cancers). So, it makes good sense for the more concerning pathologies to use dense dose chemotherapy utilizing a WBC booster. The main point is what booster to use – Neulasta or Leukine. Many of you know that I refused Neulasta and used Leukine instead. My rationale is that Neulasta (or Neupogen which is the same drug by a different company) only boosts the neutrophils (that fight short term infection) while Leukine boosts all components of the white blood cell system including monocytes and especially dendrites (the scouts that find cancer and induce the body to manufacture killer Tcells against that). Since both products could have potential negative effects, at least utilize dense dose chemo with Leukine (where one might have the potential to self vaccinate). All the Her2 vaccine trials use Leukine in conjunction with the active to further promote vaccination due to the dendritic effect.

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So, hopefully some of you will respond and we can have a healthy discussion on this. Hope you are doing well Angel. I am and will email you sometime this weekend.

[AlaskaAngel]

Thanks Becky. Do you know how far out the numbers for improved survival with blood boosting apply to? I'm tempted to do a poll of all of us old-timers here just to see if the blood boosting oxygenation is a short-term effect that maybe works best concurrently with chemo, or if it is a long-term one.

I wondered also whether maybe one reason the younger women tend to have more aggressive cancer might be because their bones are better at producing blood cells whereas the older women's systems probably produce fewer blood cells.

I enjoy sharing thoughts, and marvel that you keep the busy schedule that you do, Becky!

A.A.

[Becky]

There were no numbers. The article was written by a guy who was touting supplements etc. The link was sent to me by my husband's cousin who is a nuceutical salesman (and the article sounded very charlitan to me) but the premise of boosting the red count to increase physiological oxygenation sounded reasonable. However, Procrit's own label states otherwise and they make the drug. The article/link was sent to me over 2 years ago but I am trying to look for it.

[Bev]

AA and Becky, I have been anemic most of my adult life. I did take iron supplements in the past 10 years as directed. Sometimes I worry that Iron could have fed things. Maybe anemic is normal. Maybe it's disastrous to feed iron to ER+. Maybe offering Procrit to cancer patients is wrong too. We just have to take our best guess. I turned down nuelasta after my first try at it. It made my counts skyrocket, but they also came back when I didn't do it either.

I just don't know. BB

[Mary Jo]

Hello,

I never became anemic during chemo, so never needed Procrit. Not sure if that's good or bad. Thinks it's good.

Mary Jo

[dlaxague]

I love speculation. I'm not sure I follow the reasoning on this one, though. When we talk of circulation to tumors, aren't we usually talking about the actual network of blood vessels, rather than the number of red or white cells within them? I think that is two completely different things going on. For example, that article recently posted about surgery perhaps stimulating mets talked about angiogenesis (making a network of blood vessels to support tumor growth).

It will be interesting to see when they look closer at what's going on with the Procrit information whether the outcomes relate to actual levels of red blood cells achieved after its administration, or to dose of the med(s), or to something else altogether. The suggestion that its safer when tthe target Hgb is below 12 does lend support to the theory that AA proposed.

Just anecdotally, my Hgb is pretty high, it didn't take too hard a hit during treatment (no procrit), and I'm NED at 6 years out. I got LOTS of neupogen, however. Neupogen and Nuelasta are sort of the same drug, btw - both made by Amgen. Neulasta is the long-acting one, given once each cycle. Neupogen is the older version given daily for varying periods. I wonder now if that isn't the better choice, as probably not everyone needs the mega dose of Nuelasta and could get by with just one or two Neupogen injections, which could perhaps be safer. Perhaps. Maybe. So much to know.

As long as we're speculating and letting our mind wander - there has been discussion of treating lymphedema with vascular endothelial growth factors which might stimulate growth of new lymphatic pathways to make up for the ones lost to axillary surgery. But the question there is could that also stimulate cancer growth (perhaps as removing a tumor does)? Perhaps. Maybe.

And lastly, more speculation and rambling: As long term data emerge on the use of blood cell stimulants of all types, I wonder about myelodysplasias in the long term. We know that chemo increases risk of leukemia, but could the blood cell stimulants (I'm too lazy to look up the technical terms, sigh) contribute to this also? Again an anecdote: I have a friend who was diagnosed and treated for a relatively friendly breast cancer last fall (lumpectomy and rads only). Routine lab work during this time revealed thrombocytosis (too many platelets). I'll omit the discussion of that disease but it resulted in a referral to Stanford's bone marrow transplant program and the physician that she saw there first assumed that her condition (which will eventually require BMT) was secondary to treatment for breast cancer. That was not the case for her, but I wonder, since he quickly made that assumption, how many times he does see bone marrow failure post breast cancer chemo, and if anyone's looking at the incidence of that related to the different kinds of chemo, and also to the use of blood cell stimulants. The scenario for my friend's condition is that initially (now), her bone marrow is running amok, producing too much, but that over time this will lead to failure and no production (hence the need for BMT). Hmm. That's sort of what Nuepogen and Procrit do - cause production to run amok, right? Again, just speculation.

Debbie Laxague

[AlaskaAngel]

It is good to hear from you, Debbie! I enjoy hearing your thoughts on this, in combination with the article about possible implications of surgery....

You already know I don't give up easily and I know you don't take offense if I question the idea that the building of the vascular network and the actual volume of blood cells mean 2 different things are going on. Sometimes my thinking can be too simplistic, so if I don't fully understand what you mean I trust you will explain further. I'm thinking that building a network of vessels could still be stimulated by some body response, but isn't it the blood cells themselves that provide the "fuel" for the growth of the cancer cells? So the network itself would be there but there would still be inadequate supply of the right materials to adequately encourage cancer cell growth?

I don't want to rush the discussion too much. But a bigger question I have is, if there is a less toxic substance than the chemotherapy that messes with the GI system and the integumentary system, but that still brings on the condition of lower blood counts, and if it were also controllable by dose or frequency of dose so that it was reversible, and if it wasn't otherwise toxic (admittedly lots of ifs), would it work well enough to allow us to move away from chemotherapy? Or even at least move toward using less chemotherapy in conjunction with the lowered blood counts?

AlaskaAngel