3.2 Growth Factors - Comeau

Supportive Care Lecture

what factors stimulate the maturation and production of WBCs?

colony stimulating factors (G-CSF)

colony stimulating factors (G-CSF) reduce ____ but does not prevent it

length of neutropenia

T or F:

colony stimulating factors (G-CSF) can prevent neutropenia

F

what 4 things can be reduced by colony stimulating factors (G-CSF)?

length of neutropenia

hospitalization

rates of infection

incidence of neutropenic fever

colony stimulating factors (G-CSF) DO NOT increase ____

overall survival

WBC CSFs are indicated for primary prevention of…

febrile neutropenia

When are WBC CSFs indicated for primary prevention of febrile neutropenia?

when the risk of febrile neutropenia is >/= 20%

are WBC CSFs used for prevention or treatment of febrile neutropenia?

prevention only

When are WBC CSFs used for secondary prevention?

prior to febrile neutropenic events

name the two (2) WBC GSF products available

filgrastim and pegfilgrastim

filgrastim:

1. dosing

2. frequency

1. weight based

2. daily

pegfilgrastim:

1. dosing

2. frequency

1. 6 mg

2. one time

filgrastim:

1. when to start

2. when to stop

1. 1-4 days after chemotherapy is complete

2. when the ANC is normal or near normal (>500)

pegfilgrastim:

when to give?

1-4 days after chemotherapy is complete

(must be 12 days or more BEFORE the next chemo cycle)

main side effects of filgrastim and pegfilgrastim

bone pain

thrombocytopenia is associated with decreased ____ and increased _____

platelets

bleed risk

When are platelet transfusions indicated in thrombocytopenia?

severe thrombocytopenia or if acute/active bleed

romiplostim class

thrombopoietin peptide mimetic

romiplostim is associated with which ADE?

increased risk of VTE

What should be done before treating anemia in a cancer patient?

rule out other causes like an iron deficiency

When should PRBC transfusion be given in anemia?

if the patient is symptomatic give them transfusion

What is the role of erythropoiesis-stimulating agents (ESAs)?

stimulate RBC production

Name erythropoiesis-stimulating agents

erythropoetin and darbepoetin

What works faster: PRBC transfusion or ESAs?

PRBC is immediate

ESAs in cancer patietns should only be used in pts who…

are on myelosuppressive chemo for palliative intent or those who refuse blood products

ESAs for cancer pts have fallen out of favor due to…

risk of thromboembolism and shortening overall survival