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Pegfilgrastim (Neulasta) is a covalent conjugate of recombinant methionyl human granulocyte colony-stimulating factor (filgrastim). Administration of exogenous G-CSF results in increased total neutrophil counts, including mature, banded, and precursor neutrophils, without increasing the number of basophils, eosinophils, or monocytes. The rise in neutrophils is due to increased production by the bone marrow and not increased survival of neutrophils. G-CSF also affects selected neutrophil functions including enhanced phagocytic ability, priming of cellular metabolism associated with respiratory burst, antibody-dependent killing, and the increased expression of some functions associated with cell surface antigens.
Pegfilgrastim (Neulasta) dosage:
For chemotherapy-induced neutropenia prophylaxis, to decrease the incidence of febrile neutropenia, in patients with nonmyeloid malignancies receiving myelosuppressive chemotherapy associated with an expected incidence of febrile neutropenia >= 17%:
Parenteral dosage:
Adults and adolescents >= 45 kg: 6 mg SC once per chemotherapy cycle. Pegfilgrastim should not be administered either 14 days before or 24 hours after administration of cytotoxic chemotherapy.
Adolescents, children, or infants < 45 kg: Not recommended.
The most commonly reported adverse events reported include bone pain, myalgia, and arthralgia.
Pegfilgrastim (Neulasta) is pregnancy category C.
Filgrastim (Neupogen), is a human granulocyte colony-stimulating factor (rhuG-CSF) produced by recombinant DNA technology. Clinically, filgrastim is used to reduce the duration of neutropenia and incidence of infection in patients receiving myelosuppressive chemotherapy or bone marrow transplantation, for mobilization of peripheral blood progenitor cells for collection, and for patients with severe chronic neutropenia.
Filgrastim (Neupogen) dosage:
For the treatment neutropenia:
for the treatment of severe chronic congenital neutropenia:
NOTE: Filgrastim has been designated an orphan drug by the FDA for this indication.
Subcutaneous dosage:
Adults and children: 6 mcg/kg SC twice daily. Titrate dose based on individual's ANC. The target ANC is 1500-10,000/mm3.
for the treatment of severe chronic cyclic neutropenia or idiopathic neutropenia:
NOTE: Filgrastim has been designated an orphan drug by the FDA for this indication.
Subcutaneous dosage:
Adults and children: 5 mcg/kg SC once daily. Titrate dose based on individual's ANC. The target ANC is 1500-10,000/mm3.
in patients with myelodysplastic syndrome-:
Parenteral dosage:
Adults: 5 mcg/kg/day IV/SC, rounded to the nearest vial size. Although data supporting the routine, long-term use of filgrastim is lacking, intermittent administration may be considered in patients with severe neutropenia and recurrent infection.
for patients with nonmyeloid malignancies following autologous or allogeneic bone marrow transplantation (BMT) to reduce the duration of neutropenia and febrile neutropenia:
NOTE: Filgrastim has been designated an orphan drug by the FDA for this indication.
Parenteral dosage:
Adults and children: 5-10 mcg/kg/day IV/SC or by continuous SC or IV infusion. ASCO clinical guidelines recommend a dose of 5 mcg/kg IV or SC once daily, rounded to the nearest vial size. The first dose should be administered at least 24 hours after the last dosage of cytotoxic chemotherapy and at least 24 hours after bone marrow infusion. The manufacturer recommends the following dosage titration during the neutrophil recovery period: 1) if the ANC > 1000/mm3 for 3 consecutive days, reduce dose to 5 mcg/kg/day; 2) if the ANC remains > 1000/mm3 for 3 consecutive days following dosage reduction, discontinue drug. If the ANC decreases to < 1000/mm3 following dose reduction or discontinuation, increase dose to 10 mcg/kg/day or resume filgrastim at 5 mcg/kg/day, respectively, and follow previous steps.
For chemotherapy-induced neutropenia prophylaxis in patients receiving myelosuppressive chemotherapy and to decrease the incidence of febrile neutropenia:
-in patients with a previous episode of febrile neutropenia (secondary prophylaxis) or as primary prophylaxis in patients receiving chemotherapy regimens with an expected incidence of febrile neutropenia >= 40% or in the presence of comorbid factors:
Parenteral dosage:
Adults and children: 5 mcg/kg/day IV/SC or by continuous SC or IV infusion. Dosage may be rounded to the nearest vial size. Starting filgrastim therapy within 24-72 hours following chemotherapy provides optimal neutrophil recovery. Therapy should be continued for 7-14 days, until the absolute neutrophil count (ANC) reaches 10,000/mm3 following the expected chemotherapy-induced nadir. However, a shorter duration of administration that is sufficient to achieve clinically adequate neutrophil count is a reasonable alternative.
-as primary prophylaxis for febrile neutropenia and to reduce the time to neutrophil recovery and duration of fever following induction or consolidation chemotherapy for acute myeloid leukemia (AML):
NOTE: Filgrastim has been designated an orphan drug by the FDA for this indication.
Parenteral dosage:
Adults and children: 5 mcg/kg/day IV/SC or by continuous SC or IV infusion. Dosage may be rounded to the nearest vial size. Starting filgrastim therapy between 24-72 hours following chemotherapy provides optimal neutrophil recovery. This dosage should be continued for until the absolute neutrophil count (ANC) reaches 10,000/mm3 or ANC is > 1500/mm3 for 3 consecutive days following the expected chemotherapy-induced nadir. Beneficial effects on duration of hospitalization and incidence of severe infections following induction therapy have been variable and modest. Patients >= 55 years of age are most likely to benefit from filgrastim therapy. There seems to be a profound shortening of the duration of neutropenia after consolidation therapy for patients with AML in remission.
For peripheral blood stem cell (PBSC) mobilization prior to and during leukapheresis in cancer patients preparing to undergo bone marrow ablation:
NOTE: Filgrastim has been designated an orphan drug by the FDA for this indication.
Subcutaneous dosage:
Adults and children: 10 mcg/kg/day SC, either as an injection or by continuous infusion. Dosing should start at least 4 days before the first leukophoresis procedure and continue until the last leukophoresis procedure. A safe and effective schedule involved administration of filgrastim for 6-7 days, with leukapheresis on days 5, 6, and 7. An optimal regimen has not been identified. Neutrophil counts should be monitored and dosage reduction should be considered for those patients who develop a WBC > 100,000/mm3.
The most commonly reported adverse events associated with Neupogen include bone pain, nausea, vomiting and headache.
Filgrastim(Neupogen) is pregnancy category C.
Sargramostim (Leukine) is a human granulocyte-macrophage colony-stimulating factor (rhuGM-CSF) produced by recombinant DNA technology. Clinically, Sargramostim is used to reduce the duration of neutropenia and incidence of infection in patients receiving myelosuppressive chemotherapy or bone marrow transplantation, for mobilization of peripheral blood progenitor cells for collection, and for bone marrow graft failure or engraftment delay.
Sargramostim (Leukine) dosage:
For the treatment of neutropenia:
for promotion of myeloid recovery and decreasing the period of neutropenia in patients with Hodgkin's disease, non-Hodgkin's lymphoma, or acute lymphocytic leukemia following autologous Hematopoietic stem cell transplantation (SCT) or for any patient undergoing HLA-matched related allogeneic SCT:
NOTE: Sargramostim has been designated an orphan drug by the FDA for this indication.
NOTE: Immediately discontinue Sargramostim if blast cells appear or disease progression occurs. If a severe adverse reaction occurs or if the ANC exceeds 20,000 cells/mm3, temporarily stop Sargramostim or reduce the dose by 50% until the reaction abates.
Parenteral dosage:
Adults: 250 mcg/m2/day IV over a 2-hour period beginning 2-4 hours following infusion of bone marrow and not less than 24 hours after the last dose of chemotherapy or radiotherapy. Patients should not receive Sargramostim until the post marrow infusion ANC is < 500/mm3. Continue until an ANC 1500/mm3 for 3 consecutive days is attained.
For chemotherapy-induced neutropenia prophylaxis in patients receiving myelosuppressive chemotherapy and to decrease the incidence of febrile neutropenia:
in patients >= 55 years with acute myelogenous leukemia:
NOTE: Sargramostim has been designated an orphan drug by the FDA for this indication.
NOTE: Immediately discontinue Sargramostim if leukemia regret occurs. If a severe adverse reaction occurs or if the ANC exceeds 20,000 cells/mm3, temporarily stop Sargramostim or reduce the dose by 50% until the reaction abates.
Parenteral dosage:
Adults >= 55 years: 250 mcg/m2/day SC or IV over a 4 hour period starting approximately on day 11 or 4 days following the completion of induction chemotherapy if, at that time, the day 10 bone marrow was hypoplastic with <= 5% blasts. Sargramostim should be continued until an ANC > 1500/mm3 for 3 consecutive days or a maximum of 42 days. If a second cycle of induction chemotherapy is necessary, Sargramostim should be administered as above beginning approximately 4 days after completion of the second induction course if the bone marrow is hypoplastic with < 5% blasts.
The most commonly reported adverse events associated with the use of Sargramostim (Leukine) include bone pain, peripheral edema, myalgias and arthralgias.
Sargramostim (Leukine) is pregnancy category C. | 
