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6 MP - what is too low a white blood count?

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Posted 9/28/2007 10:31 AM (GMT -6)
I've been on 6 MP, only 50 mg per day, for about 2 months and my white blood count keeps dropping slowly. It is now 3.6.  (Was 5.2, 4.6. 4, 3.8, 3.6 etc.) I had blood tests every week for the first month, now every 2 weeks - my doctor says if it goes below 3.5, we may need to re-think the medication.  I had resection back in April and we were hoping 6 MP in addition to pentasa may help prolong remission.  Other than being a little tired, I seem to be handling the 6 MP OK.

Thanks,

PGK 

Posted 9/28/2007 11:15 AM (GMT -6)

Hi, I am not on 6 mp yet but know from my daughter who had leukemia and was on 6mp for 3 years that everyone metabolizes this drug differently.  There is a prometheus test that can check your TPMT level which can tell you if you are an average, below average or above average metabolizer of the 6mp.  I just got my results yesterday and it says I am way below normal at 21.0 so they are starting me on azithopan(spelling??) like 6mp but 50% of dose.  He thinks 6mp will bottom me out.  My GI likes to see the wbc between 3.0-4.0.  Again, from my daughter's experience when you get a cold whether it is viral or bacterial it can either lower your wbc or higher it.  That is a good time to get the wbc checked.  There is also a drug called GCSF if the wbc gets too low for too long and you need to recover.  Probably much more info than you needed but finally something I know since I am a crohns newbie!!

Good luck

Chris

Posted 9/28/2007 11:59 AM (GMT -6)
Leukopenia -- lowe white blood count -- is the primary side effect of 6mp and occurs in about 10-15% of patients. It is almost always easily reversed when meds are stopped. Sometimes patients can also correct it with a lower dose, but unfortunately you are on the minimum does of 50mg, as am I. I have seen some posts that indicate that patients who have blood count problems from either 6mp or imuran (which basically metabolizes in the boy into 6mp) can have slightly different and better results from switching between the two of them, which are pretty much interchangable. I've also seen a few posts from people who had dropping white counts when they first started 6mp and stoppped it and went back in a few months with no side effects resuming. Unfortunaely, if the low white count persists after trying those alternatives, it probably means this med isn;t for you.

Posted 9/28/2007 2:05 PM (GMT -6)

I was just worked up for a low white cell count, specifically the neutrophils. My situation is a little different in that I'm not taking a drug known to lower the WBC like 6-MP but it is still a low WBC, with the same risks, i.e. the inability to fight infection.  

The hematologist I saw said that my WBC, which just dropped from 30 years at 3-3.6 down to 2.2 was not too concerning.  I had asked him about treatment with methotrexate which had been considered at one time and he said it would require dosing considerations and extra monitoring but it was not ruled out, even with a WBC this low starting the treatment.   So, even though a normal WBC ranges from 4-11,000 it can go considerably lower before there are serious concerns. Even at a level of 2.2 I  don't have a problem with infections

Posted 9/28/2007 8:46 PM (GMT -6)
I'm one that couldn't tolerate 6-mp at all.  I got pancytopenia which is lower red blood cells, white blood cells and platelets.  Ended up in the hospital in isolation for almost 2 weeks.  It happened pretty fast, in just a few weeks after my doctor upped my dose to 150mg.  I'm thinking that 50mg or even 100mg would have been okay for me.
Posted 9/29/2007 4:10 PM (GMT -6)
I don't mean to change the topic but I see you are on Cymbalta, Vicky. How is that working for you? I tried that because of chronic pain in my feet and it worked great for that- within a couple of days my foot pain was gone. However, my blood pressure went way up and I had to stop it.

Chris
Posted 9/29/2007 6:22 PM (GMT -6)
hey there,
my wbc's currently are at 2.6 (i take 6mp 50mg daily then 75extra mg's each friday). the lowest i've even been was 2.0
hate to say, but i really have to be careful, as everyone should...in crowds especially. if i go out to say the theater for a movie or sit at a restaurant...in a matter of 3 days i'm w/ a fever & swollen glands.
my doc has me keep antibiotics on hand just in case.
do you feel as though you're picking up stuff? as long as you keep all your lab appts, your docs keep a good eye on your wbc's.
btw...i'm on many immuno-suppressants so my input may not fit too much for just 6mp alone.
be safe, stay well.
Posted 10/1/2007 7:17 AM (GMT -6)
Chris, I just saw you message to me. I happen to love cymbalta. In just a few days I was able to climb stairs, work out on the eliptical and deal with the daily stress of having several chronic illnesses. It also helped me lose weight which I desperately needed to do. I've been on it for about 3.5 months and so far so good. When I first started taking it, it was pretty rough but after a week I was feeling great. Even my family noticed a difference in my attitude.
Posted 10/2/2007 6:19 AM (GMT -6)
Hi Vicky:

That's great that it is working for you so well. I had big hopes when it worked so quickly on my feet but what it did to my blood pressure, yikes. She had warned me to keep an eye on my blood pressure because sometimes it elevates it and sure enough, that's what happened.It sure worked well for my foot pain.
Posted 10/2/2007 6:19 AM (GMT -6)
Hi Vicky:

That's great that it is working for you so well. I had big hopes when it worked so quickly on my feet but what it did to my blood pressure, yikes. She had warned me to keep an eye on my blood pressure because sometimes it elevates it and sure enough, that's what happened.It sure worked well for my foot pain.
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