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Chapter 56

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  1. Chapter 56 Hematopoietic Agents

  2. Hematopoietic Agents • Process by which blood cells and platelets are produced • Types • Hematopoietic growth factor • Erythropoietic (RBCs) • Leukopoietic (WBCs) • Thrombopoietic growth factor • Oprelvekin (platelets)

  3. Erythropoietic Growth Factors • Also known as ESAs (erythropoiesis-stimulating agents) • Adverse effects • Increased risk of deep vein thrombosis (DVT) when used before elective surgery • For patients with cancer • Can shorten time to tumor progression • Reduce overall survival

  4. Epoetin Alfa (Erythropoietin) • Brand names: Epogen, Procrit • Hematopoietic growth factor • Significant effects outside hematopoietic system • Recombinant DNA technology • Uses • Anemia associated with chronic renal failure • Chemotherapy-induced anemia • For HIV-infected patients taking zidovudine • Anemia in patients facing surgery

  5. Epoetin Alfa (Erythropoietin) • Adverse effects • Hypertension • Autoimmune pure red-cell aplasia • Very rare • Cardiovascular events • Cardiac arrest • Hypertension • Heart failure • Thrombotic events (stroke and MI)

  6. Epoetin Alfa (Erythropoietin) • Warnings • Excessive dosage • Cancer patients • Renal failure patients • Preoperative patients • Risk evaluation and mitigation strategy

  7. Epoetin Alfa (Erythropoietin) • Dosage • To minimize risks • Use minimum needed to gradually raise hemoglobin content to eliminate the need for RBC transfusions • Hemoglobin level should not exceed 12 g/dL • Monitoring • Monitor hemoglobin level twice weekly

  8. Longer-Acting Erythropoietins • Darbepoetin alfa (long-acting) • Similar risks and needs for monitoring as epoetin alfa • Patients with hypertension may need increased hypertension medications • Methoxy polyethylene glycol: epoetin beta (very long-acting) • Not marketed in the United States (ongoing patent dispute)

  9. Filgrastim (Neupogen) • Granulocyte colony-stimulating factor • Leukopoietic growth factor • Recombinant DNA technology • Reduces the incidence of severe neutropenia • Produces dose-dependent increase in circulating neutrophils • Reduces the incidence of infection, need for hospitalization, and need for intravenous antibiotics

  10. Filgrastim (Neupogen) • Uses • Cancer • Severe chronic neutropenia • Adverse effects • Bone pain • Leukocytosis

  11. Pegfilgrastim (Granulocyte Colony-Stimulating Factor) • Long-acting • Derivative of filgrastim (Neupogen) • Stimulates myeloid cells to increase production of neutrophils • Adverse effects • Similar to filgrastim • May require opioids for pain relief

  12. Sargramostim (Granulocyte-Macrophage Colony-Stimulating Factor) • Brand name: Leukine • Hematopoietic growth factor • Recombinant DNA technology • Uses • Adjunct to autologous bone marrow transplantation • Treatment of failed bone marrow transplants • Patients with acute myelogenous leukemia (AML) • Adverse effects • Leukocytosis • Thrombocytosis

  13. Oprelvekin (Interleukin-11) • Brand name: Neumega • Thrombopoietic growth factor • Recombinant DNA technology • Uses • Used with myelosuppressive chemotherapy to minimize thrombocytopenia and to decrease the need for platelet transfusions • Adverse effects • Fluid retention • Cardiac dysrhythmias • Effects on the eye • Sudden death

  14. Drugs Related to Hematopoietic Growth Factors • Romiplostim • Eltrombopag • Plerixafor

  15. CAUTION • Epoetin alfa, filgrastim, sargramostim, and oprelvekin stimulate proliferation of bone marrow cells. • USE WITH GREAT CAUTION, if at all, for patients with cancers of bone marrow origin.