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What is primary prophylaxis of neutropenia?
- use of CSF before any occurence of neutropenia
- given when risk of febrile neutropenia is at least 20% -OR-
- when risk is low-moderate and pt has individual risk factors
What is secondary prophylaxis of neutropenia?
use of CSF to prevent recurrent neutropenia
What is treatment of neutropenia?
- use of CSF as part of the tx of febrile neutropenia
- NOT recommended - no real improvement is seen
What are the individual risk factors for febrile neutropenia?
- > 65yo
- Co-morbidities (COPD, DM, CVD, Liver disease, Renal dysfunction)
- Presence of active infection
- Decreased immune fx
- Poor performance status
What are the options for someone who developed neutropenia in a previous stage of chemo?
- decrease dose
- increase interval
- start secondary prophylaxis
What are the CSFs used in prophylaxis of neutropenia?
What is the MOA of CSF?
- stimulate proliferation and differentiation of hematopoietic cells in the granulocyte lineage
- Sargramostim also has activity in the macrophage lineage (no proven benefit yet)
Which CSF has the longers half-life?
Pegfilgrastim = 15-80hrs (others are ~3hrs)
What is the dose of Filgrastim for prophylaxis of neutropenia?
5 mcg/kg/d SQ until ANC is at least 2000/mm3
What is the dose of Pegfilgrastim for prophylaxis of neutropenia?
6 mg SQ once per cycle
What is the dose of Sargramostim for prophylaxis of neutropenia?
250 mcg/m2/d SQ until ANC is at least 2000/mm3
When should CSF be initiated for prophylaxis of neutropenia?
- 24-72hrs after chemotherapy
- if given before then, neutropenia gets worse!
What are the SE of Filgrastim and Pegfilgrastim?
- Bone pain
- Allergic-type rxns
- Splenic rupture (rare)
What are the SE of Sargramostim?
- Fluid retention
- Respiratory sx
- Cardiovascular sx
- Renal/hepatic dysfunction