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e-learning GCSF. John Murray Nurse Clinician BMT. The Christie NHS Foundation Trust. Nursing Education. Already exists Immune thrombocytopenia Chronic myeloid leukaemia Adherence and compliance in CLL Bone health in multiple myeloma Haematopoitic stem cell mobilisation and apheresis

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E learning gcsf

e-learningGCSF

John Murray

Nurse Clinician BMT

The Christie NHS Foundation Trust


Nursing education

Nursing Education

  • Already exists

    • Immune thrombocytopenia

    • Chronic myeloid leukaemia

    • Adherence and compliance in CLL

    • Bone health in multiple myeloma

    • Haematopoitic stem cell mobilisation and apheresis

    • GvHD video

The Christie NHS Foundation Trust


Whose fault is it

Whose fault is it?

  • The committee +1

The Christie NHS Foundation Trust


Gcsf idea

GCSF idea

  • Crystal structure

The Christie NHS Foundation Trust


What did we want to do

What did we want to do?

  • Education

  • Cross borders

  • Be on line

  • Current?????

  • Backed by a teaching institution

  • Informative

  • Useful across countries

  • No one product to dominate

  • Test!

  • Validated

The Christie NHS Foundation Trust


The package

The Package

  • What is GCSF

  • History

  • Biology

  • Where is it from

  • How does it work

  • Approved uses

  • Types of GCSF available

  • Instructions on use

The Christie NHS Foundation Trust


Brief run through

Brief run through

  • Very quick

The Christie NHS Foundation Trust


What is gcsf

What is GCSF?

  • Name comes from discovery method

  • Colonies

  • Macrophages for.....

  • Granulocyte........

The Christie NHS Foundation Trust


History

History

  • 1983 Australia Walter and Eliza Hall Institute

  • Purified mouse GCSF

  • Groups in Japan Germany USA followed in 1986 with human clone version

  • 2 main companies at first

  • Amgen had neupogen (filgrastim) 1989

  • Chugai had granocyte (lenograstim) 1991

The Christie NHS Foundation Trust


Biology

Biology

  • Produced by endothelium, macrophages and other immune cells

  • Exists in 2 forms

  • GCSF receptor present on precursor cells in BM

  • Response to GCSF cells proliferate and differentiate into mature granulocytes

  • Potent inducer of HSC mobilisation

  • Main use is for

    • mobilisation

    • decrease incidence of neutropenia

The Christie NHS Foundation Trust


Where does gcsf come from

Where does GCSF come from?

  • Amgen produce filgrastim by recombinant technology the human GCSF gene is inserted into an e-coli bacteria

  • Although pharmacologically equivalent slight difference between e-coli produced and Chinese Hamster Ovary cell derived GCSF pharmacokinetically

  • Chugai produce lenograstim by synthesis in CHO cells, makes it indistinguishable from human GCSF

The Christie NHS Foundation Trust


How does it work

How does it work?

  • Binds to cell surface receptors stimulates proliferation, differentiation, commitment and end cell function

The Christie NHS Foundation Trust


Approved uses

Approved uses

  • UK

  • BCSH 2003, ASCO 2006 and NCCN guidelines

  • Please use own country guidance

  • SOP

  • JACIE agreed criteria for your hospital

The Christie NHS Foundation Trust


Prophylaxis

Prophylaxis

  • Primary prophylaxis

    • Not routinely for previously untreated patients

    • High risk patients 40%+ risk

  • Secondary prophylaxis

    • Those who had febrile neutropenia with first cycle

  • Adjuctive use

    • Not to use routinely with antibiotics as adjunctive with uncomplicated FN <10days

The Christie NHS Foundation Trust


With chemotherapy

With chemotherapy

  • AML consolidation to reduce in pt stay

  • ALL to reduce severity of neutropenia

  • MDS reduce severity neutropenia

  • Aplastic trial basis only

  • Lymphoma to reduce incidence of infection, chemotherapy delay and hospitalisation

The Christie NHS Foundation Trust


Mobilisation

Mobilisation

  • Dose by weight, tables available

  • Mount Vernon Guidelines 2010

  • Chemotherapy prime + GCSF

  • GCSF alone

  • Biosimilars not recommended by EBMT 2011

The Christie NHS Foundation Trust


How to give

How to give

  • Product literature

  • Link to drug websites

The Christie NHS Foundation Trust


E learning gcsf

  • How do I prepare my Neupogen injection?

  • Before you inject Neupogen you must do the following:

  • To avoid bending the needle, gently pull the cover from the needle without twisting as shown in pictures 1 and 2.

  • Do not touch the needle or push the plunger.

  • You may notice a small air bubble in the pre-filled syringe.

  • You do not have to remove the air bubble before injecting. Injecting the solution with the air bubble is harmless.

  • You can now use the pre-filled syringe.

  • Where do I give my injection?

The best places to inject are the top of your thighs and the abdomen. If someone else is injecting you, they can also use the back of your arms.

You may change the injection site if you notice the area is red or sore.


Plerixafor

Plerixafor

  • Originally for HIV

  • Genzyme product

  • Licensed for lymphoma and myeloma poor mobilisers

The Christie NHS Foundation Trust


E learning gcsf

  • Plerixafor

  • Dose: Plerixafor (Mozibil™) ADULT over 18 years, 240 micrograms/kg daily 6-11 hours

  • before initiation of apheresis; usual duration 2-4 days (max. 7 days) by subcutaneous

  • injection. Mozobil injection supplied as 1.2mL-vial

  • Indications

  • Peripheral Blood Stem Cell Mobilisation, with G-CSF in patients with Lymphoma or Myeloma

  • Instructions for injecting Plerixafor

  • You will most likely receive your Plerixafor injections at your transplant center or hospital, depending on hours of operation.

  • Plerixafor will be given to you as an injection under your skin (this is called a subcutaneous injection).

  • A member of your healthcare team will inject the medication into a fleshy part of your body (such as your hip or leg).

  • Plerixafor is given in combination with G-CSF. Your doses of G-CSF should be given each day starting 4 days before your first evening dose of Plerixafor and every morning you are scheduled for a session of apheresis.


Questions for you

Questions For You

  • Why is it called Granulocyte Colony Stimulating Factor?

  • When and where were Granulocyte Colony Stimulating Factor first discovered?

  • Who were the first 2 companies to develop a product?

  • Where does Granulocyte Colony Stimulating Factor come from?

  • How does Granulocyte Colony Stimulating Factor work?

  • What are the 6 approved uses for Granulocyte Colony Stimulating Factor?

  • What types of Granulocyte Colony Stimulating Factor are available?

  • What are the main side effects of G-CSF?

  • What is Stem Cell Factor (Plerixafor™)?

  • How does Plerixafor™ work?

  • When do you use Plerixafor™?


Questions for me

Questions for me?

  • Time to go

The Christie NHS Foundation Trust


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