Triple Negative Breast Cancer - frequent pauses in chemo due to low Neutrophils

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My daughter is having ongoing problems with getting regular chemo due to repeated lowering of white blood cells (Neutrophils)

She can manage two or, if she is lucky, three cycles, then has to be paused for one, two or even three weeks. This has happened with Carboplatin and Paclitaxel, EC, Carboplatin-Taxol and most recently Capecitabine.  Strength of chemo has also been progressively reduced to 65%.  She now also has Filgrastin injections which do help.

I have three main questions.

Is there a suitable type of chemo that is delivered at three-weekly intervals, giving her neutrophils a better chance to improve between doses and sustain regular treatment?  I watched a programme about Sarah Beeney's cancer treatment, her chemo was every three weeks.

Would a Haematologist be able to advise how to help improve her neutrophils?

Is it possible to have a transfusion of neutrophils, similar to transfusions for anaemia?

Finally, would going privately for another diagnosis and treatment be helpful?

Thank you 

  • Hi Maroon Sky

    Thanks for getting in touch.

    My name is Paula and I am one of the Cancer Information Nurse Specialists on the Macmillan Support Line.

    I am sorry to hear your daughter has been having frequent treatment delays due to her neutrophil count. I can understand your concerns and can imagine how worrying this must be for your daughter and yourself.

    As you are aware, the most common cause of neutropenia is cancer treatment such as chemotherapy. It targets rapidly dividing cells such as cancer cells, blood cells as well as healthy cells. However not everyone develops neutropenia, the symptoms and how severe they are can vary for individuals. A person’s neutrophil levels often return back to normal once treatment has been completed. Treatment delays, dose reductions and Filgrastim (G-CSF) can help to manage this difficult side-effect.

    Depending on the type of breast cancer a person has determines how they treat it and how frequently chemotherapy is given. It’s good to hear that Sarah Beeny is doing well after completing her treatment.  

    According to information read online Sarah’s last treatment wasn’t given as her liver enzymes where too high, and she also had problems with her neutrophil count. The other factor to consider is her diagnosis may be different from your daughters and the treatment given may not be the same.   

    You mention your daughter has already had a range of chemotherapy treatments so far and faced similar problems. As the team have already dose reduced the chemotherapy, it might be worth asking them if they have considered other drugs that might help her neutrophil count if they haven’t considered this before.

    Sometimes the oncologist can refer patients to a Haematologist if the neutrophil count remains low post treatment. However, if a patient is on treatment, they may presume it’s due to chemotherapy induced neutropenia and might not need to intervene at this stage. Generally, however the oncologist has expertise in managing a low neutrophil count, so a haematologist isn’t always consulted.  

    I can understand your question about a transfusion of neutrophils similar to a blood transfusion for anaemia. We would suggest speaking to your daughter’s oncologist about this as G-CSF is normally adequate at managing a low neutrophil count.

    I know it’s frustrating that your daughter has constant treatment delays and you’re considering getting a second opinion from the private sector. A second opinion will not give another diagnosis but may offer different treatment options.

    However before asking for a second opinion, it’s worth your daughter talking to her current team, especially if she is concerned with her treatment and how it’s being managed so far. They are in an ideal position to talk through her worries. We would suggest making a list of questions for your daughter to ask her team. You might find this link useful.  

    If you have any further questions, please don’t hesitate to get back in touch. Sometimes giving us a call can be helpful. We can talk through your concerns and discuss how we can support you more. 

    Ref: PW/SS

    Paula-Cancer Information Nurse Specialist