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Hello Doctor,
My mother aged 60 was diagnosed with Waldenstrom Macroglobenia with high risk level. She had hyperviscosity with IgM level shooting upto 7gms. plasmapheresis was done to reduce the IgM level and after that Chemotheraphy was administered with Rtiuximab and Bendamustine. The Chema was repeated for 6 cylces after every 28 days. After each Chemo between 7 -21 days of chemo she is used get fever and neutrophil counts used to go to low.She was administered antibiotics to keep the fever out. Now she has gone thru' 2 more cycles of maintainence Chemo wit Rituximab only. But lately she is been getting fever consistently with oral temp ranging from 99 degrees C to around 104 degrees C. The neutrophil count goes down to less than 500 (absolute count) each time. Each time she is given antibiotics to cut down fever and increase the neutrophil count. But this keeps repeating every 1-2 weeks after she gets normal.
Need your advice and suggestions on what could be the reason and what are other treatment solutions.
I will upload the scanned reports and the summary reports once I get it from the hospital.

Category: Oncologist

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Category: Hematologist
 32 Doctors Online

Thank you for your query at
Neutropenia (which is the decrease in neutrophil count) after chemotherapy is a usual complication of the chemo drugs. The possibility can be prevented by using growth factors to boost the immunity.
In case of repetitive episodes, please consult with your medical oncologist if dose needs to be reduced to reduce the incidence of neutropenia.
A good nutrition with high protein diet is usually sufficient to prevent neutropenia along with use of growth factors.
Feel free to discuss further,
Kind regards.

Patient replied :

Thank you Doctor. Mom was admitted to the hospital because febrile neutropenia and they had to give Filgrastim to stimulate the bone marrow. I am attaching the Medical reports.
What are those growth factors which can be given to boost immunity. Does it need to be given everyday ?

Filgrastim is a Granulocyte Colony Stimulating Factor (G-CSF).
I would advice to give Granulocyte Colony Stimulating Factor (G-CSF) injections based on the Total WBC Count and ANC (Absolute Neutrophil Count) values. The dose and duration depends on those.
There are many brands available in the market and can be purchased based on your oncologists' suggestion and availability.
It needs to be given until counts recover.

Let me know if you have further queries.

Kind regards.

Patient replied :

Thank You Doctor.
As mentioned earlier she got discharged after getting treatment for Neutropenia on 27th Sept. Today afternoon again she got fever of around 100 F. And I see that the Haemoglobin, RBC count, PCV (Packed Cell Volume), MCH have gone low. Eosinophil has increased. I am attaching the Blood count report for your reference.
Comparing the previous report (discharge report) and this report, I see that the haemoglobin has gone down from 10.2 to 7.7
Need your advice on whether we can get her treated by a local MD doctor near our hometown or Should I rush to the oncologist. The problem we have is the Oncologist or the hospital where she got treated is around 6 hours journey from my hometown.

I would prefer to be consulted with Oncologist.
But in your case, since the oncologist and hospital are far away, you can get her treated by the local MD doctor, and based on his expertise if at all it is mandatory, you can taker her to the oncologist.

Dr. Prasad Eswaran
Category: Hematologist
Doctorate in Medicine (Fellowship in Oncology), DM,  Madras Medical College & Govt. General Hospital, Chennai, India.

Doctor of Medicine (Residency in Radiation Oncology) , MD, Christian Medical College, Vellore, Tamilnadu, India, 2004-06.

Diploma in Medical Radiology & Therapy (Residency in Radiation Oncology), D.M.R.T, Madras Medical College & Govt. General Hospital, Chennai, India, 2004-06.

Bachelor of Medicine & Bachelor of Surgery - M.B.B.S, Govt. Stanley Medical College & Hospital, Chennai, India, 1998-2004.
Dr. Prasad Eswaran and 4 other Medical Specialists are ready to help you

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