Chemo Induced Neutropenia

Question 1

Neutropenia

Answer 1

Absolute neutrophil count (ANC) < 500 cells/mm^3 or expected to decrease < 500 in next 48h

Question 2

Profound neutropenia

Answer 2

ANC< 100 cells/mm^3

Question 3

Prolonged neutropenia

Answer 3

neutropenia lasting longer than 10 days

Question 4

Febrile neutropenia

Answer 4

Neutropenia +
Temp >/= 38.3 C one time orally
- OR >/= 38 C over 1 hr

Question 5

Growth factors place in neutropenia therapy

Answer 5

Primary prevention
Treatment
Secondary prevention

Question 6

Risk factors for febrile neutropenia

Answer 6

Disease
Chemo reg
- high dose
- dose dense
Pt risk factors
- prior chemo or radiation therapy
- persistent neutropenia
- bone marrow involvement by tumor
- recent surgery and/or open wounds
- liver dysfunction (bili > 2 )
- renal dysfunction (CrCl < 50)
- age > 65 yrs receiving full chemo dose intensity

Question 7

Growth factors for primary prevention:

Answer 7

High risk -> G-CSF recommended

Intermediate risk + 1 risk factor -> consider G-CSF

Low risk + 2 risk factors -> MAY consider G-CSF

Question 8

Filgrastim

Answer 8

Category 1
Short acting GCSF
Start the next day or up to 3-4 days after chemo
Given daily until ANC recovery

Question 9

Pegfilgrastim

Answer 9

Category 1
Long acting GCSF
Admin up to 3-4 days after completion of chemo
single administration
allow at least 12 days between dose of peg and next cycle of chemo

Question 10

Eflapegrastim-xnt

Answer 10

Category 2A
Long Acting GCSF
admin ~ 24h after completing chemo
single administration
do not admin 14 days before or 24h after chemo

Question 11

GCSF Treatment

Answer 11

Did patient receive prophylactic GCSF?
- received filgrastim -> continue filgrastim
- received peg or eflapeg -> no additional GCSFs (long acting agents)
- did not receive GCSFs -> assess risk factors for infection associated complication

Question 12

Indications for GCSF use in established febrile neutropenia

Answer 12

Sepsis syndrome
Age > 65
ANC < 100 cells
Neutropenia expected to be > 10 days in duration
Pneumonia or other infection
invasive fungal infection
Hospitalization at time of fever
prior episode of febrile neutropenia

Question 13

GCSF Secondary prevention

Answer 13

Pt with Hx of FN -> did they receive GCSFs in the past?
- yes -> consider chemo dose reduction or change in reg
- no -> consider GCSFs