e-learning GCSF

1. e-learningGCSF John Murray Nurse Clinician BMT The Christie NHS Foundation Trust

2. 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

3. Whose fault is it? • The committee +1 The Christie NHS Foundation Trust

4. GCSF idea • Crystal structure The Christie NHS Foundation Trust

5. 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

6. 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

7. Brief run through • Very quick The Christie NHS Foundation Trust

8. What is GCSF? • Name comes from discovery method • Colonies • Macrophages for..... • Granulocyte........ The Christie NHS Foundation Trust

9. 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

10. 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

11. 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

12. How does it work? • Binds to cell surface receptors stimulates proliferation, differentiation, commitment and end cell function The Christie NHS Foundation Trust

13. 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

14. 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

15. 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

16. 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

17. How to give • Product literature • Link to drug websites The Christie NHS Foundation Trust

22. 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.

26. Plerixafor • Originally for HIV • Genzyme product • Licensed for lymphoma and myeloma poor mobilisers The Christie NHS Foundation Trust

27. 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.

28. 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™?

29. Questions for me? • Time to go The Christie NHS Foundation Trust