Spleen and liver enlargement after Neulasta

[jlnewell]

This is my first post and we were completely ignorant about cancer until it reared its ugly face during emergency surgery in August, Stage III-b. My wife is having problems with all blood counts being low especially platelets and neutrophils. Half of the time she cannot take her chemo because her levels are too low. The onc suggested Neulasta treatments. They gave us the literature to read about it and the next week when we met with the Dr. I asked him about the side effects of ruptured spleen because her CT scans have shown mild splenomegaly since August. He wasn't concerned about so neither were we. However about 4 or 5 days after the first neulasta treatment my wife began to have discomfort in her lower rib cage area and some spasm like jolts in her left mid back. It just happened that she had a regular scheduled appoint with our PCP and she mentioned it to him and told him of our concern with the side effect of neulasta. He examined her and found her spleen to be very pronounced upon palpation, he sent her for a CT scan and found her spleen and liver enlarged. The spleen was almost 20% larger than just a month ago (now called marked splenomegaly on the radiology report), there had never been any note of liver enlargement before. The oncologist stopped the neulasta but it did raise her blood levels into the normal range for the first time in a year. Our problem is the pain and discomfort is still there and we have missed chemo twice since. Has anyone ever had such problem? Any suggestions? We are overwhelmed first with emergency surgery, then cancer now treatment and fear of worse things happening. Thank you.

[Lee]

Hi and welcome,

So sorry for what you wife has endured. It sure sounds like Neulasta is the problem.

I don't have any real answers, butt will throw this out there. Is your wife being treated locally? My suggestion, get an opinion from a major cancer treatment center or major cancer hospital. Major treatment centers tend to have top doctors in their fields and something tell they might be able to come up with a solution regarding her low blood counts, Neulasta, etc.

Where are you? There are many good hospitals in the USA. Could you travel if necessary?

How old is your wife?

Lee

[jlnewell]

Thank you for your reply, Lee. My wife is 70 we live about 50 miles north of Tulsa and go to Bartlesville where the hospital is part of a much larger health care system in Tulsa (St. John Medical Center) they are part of Oklahoma Cancer Specialists and Research Institute. This is their brochure description:
Oklahoma Cancer Specialists and Research Institute is teaming with MD Anderson Cancer Network®, a program of MD Anderson Cancer Center, to bring cancer care in Oklahoma to a higher level. As the first and only certified MD Anderson Cancer Network member in Oklahoma, the OCSRI doctors certified by the network tap into the pioneering evidence-based guidelines, treatment plans and best practices developed by the experts at MD Anderson, bringing a new level of hope to cancer patients in our community.

We like the Oncologist and he seems to be qualified and competent although very very busy with the patient load. It is very convenient from where we live. Being that we are both older and on Medicare (actually a Medicare Advantage plan) we are limited on providers but happy with what we have, everyone at the cancer center has been fantastic. However like all hospitals and doctors everywhere in the US are forced to practice defensive medicine first and foremost. We are not concerned with litigation - we are concerned that my wife's spleen might rupture and cause ever more problems with drastic consequences. Since stopping the neulasta it seems no one is concerned with the enlarged spleen pain. Perhaps we should call our PCP since he originally found the problem. The internet is full of helpful information but some doctors get very upset with internet diagnosis or input which is understandable because along with helpful info there is complete hogwash also. I was hoping to find if someone has had similar experience with neulasta for reference. Even though the manufacturer claim the occurrence of ruptured spleen is rare - it is one of the most prominent warnings.

I appreciate your response and welcome any further comment or advise. I think, as I write this, I have convinced myself to contact our PCP about our concerns and will report the findings. Hopefully it is my old-age paranoia and not as bad as I have made it to be.

[Soccermom2boys]

I am not sure how helpful this will be to build your case, but I took Neulasta 4 or 5 times over the course of my 8 FOLFOX treatments (February to June 2016). When I completed my treatments and did the follow up CT scan at the end of June 2016, it was noted that my spleen was enlarged. I didn’t do anything medically for it as I was finished with treatments, but because of that I had another CT scan six months later in December of 2016. Again, the spleen was still slightly enlarged. When I had my follow up CT scan in June 2017 it was back to normal according to report. My doctor never said it was due to the Neulasta, but that doesn’t mean it couldn’t have been. Would be interesting to hear from other Neulasta users if their scans showed any spleen enlargement? I hope you and your wife are able to get some answers and peace of mind going forward—cancer alone is more than enough to deal with, let alone having other issues crop up and tag along.

[Lee]

It does sounds like you are at a good hospital. My assumption was wrong. Yes do get in touch with your PCP, Hopefully s/he can help with her pain. You might want to have a talk with her Onc, Neulasta may not be an option for your wife. Does Onc have any other recommendations. Since she is a stage III, you really want to do some type of mope up. Maybe an immune therapy might be a better choice for her.

Good luck, hope she's feeling better soon.

Lee

[jlnewell]

I am not sure how helpful this will be to build your case, but I took Neulasta 4 or 5 times over the course of my 8 FOLFOX treatments (February to June 2016). When I completed my treatments and did the follow up CT scan at the end of June 2016, it was noted that my spleen was enlarged. I didn’t do anything medically for it as I was finished with treatments, but because of that I had another CT scan six months later in December of 2016. Again, the spleen was still slightly enlarged. When I had my follow up CT scan in June 2017 it was back to normal according to report. My doctor never said it was due to the Neulasta, but that doesn’t mean it couldn’t have been. Would be interesting to hear from other Neulasta users if their scans showed any spleen enlargement? I hope you and your wife are able to get some answers and peace of mind going forward—cancer alone is more than enough to deal with, let alone having other issues crop up and tag along.

Thank you for your helpful reply. We are not really interested in building a case, we were just concerned and seemed to be the only ones that were. Maybe I'm hypersensitive since my brother almost died with a ruptured spleen. We have been too blessed surviving emergency surgery and finding treatable cancer only to face the possibility of an exploding spleen, associated with curing the cancer. Your experience was comforting to us and exactly the kind of input we were looking for. Thank you.

[Tdubz]

After my 11 rounds of folfox, my ct scan showed a slightly enlarged spleen too, but I never had any Neulasta. Seems like this is a side effect of oxi as well.

[Dionca]

I had neulasta with 10 of my 12 treatments, and didn't experience any enlargement of the spleen.

However, after the fact, I did wonder why they didn't prescribe it on as "as needed" basis, rather than automatically give it to me each time. You could also take neupogen to boost your white blood cells, but I understand, unlike neulasta, it takes several injections, rather than just one each time.

The chemo itself can leave you with unwanted side effects. It left me with a fatty liver, which has not "defatted" with time, as well as neuropathy. I don't think the neulasta left any side effects, but it's hard to say with all the other stuff going on. All I know is, that in my case, that it did its job, and I wouldn't have been able to tolerate the chemo without it.