Lineage-Specific Hematopoietic Growth Factors

Question 1

What is hematopoiesis?

Answer 1

Process that generates blood cells of all lineages (200 billion RBCs, 100 billion WBCs, 100 billion platelets)

Question 2

EPO - explain blood levels/response process

Answer 2

Blood levels of EPO are inversely related to tissue oxygenation, juxtatubular interstitial cells of renal cortex produce 90% of EPO in blood, and sense concentration of O2

Question 3

EPO Stimulating Agents

Answer 3

• Epoetin alfa: contains identical AA sequence of isolated natural EPO
• Darbepoetin alfa
• Peginesatide

Question 4

EPO Stimulating Agents Clinical Indications

Answer 4

• Treatment of anemia (CKD, AZT-tx HIV pts, CA pts on chemo)

- Reduction of allogeneic blood transfusion in anemic nonvascular/noncardiac surgery pts (between 10-13 HgB)

Question 5

What are some things you should be monitoring with ESAs?

Answer 5

• Hemoglobin
• Blood pressure
• Serum ferritin
• Transferrin saturation
• Serum chemistries such as CBC with diff, creatinine, BUN, K+, phosphorus

Question 6

ESAs - ADRs

Answer 6

• CKD pts (pre-dialysis pts, hemodialysis pts had more access thrombosis); safer use - less is more, do not exceed 13 g/dL
• CA pts
• Major surgery (increased DVT after surgery)

Question 7

Mechanism of ADR in ESAs

Answer 7

• Complete or too rapid correction of anemia can increase BP and risk of thrombosis, accentuate vasoconstriction and increase platelet adhesiveness
• In CA pts, can increase O2 delivery to tumor

Question 8

Colony-Stimulating Factors (CSFs)

Answer 8

• G-CSF: Filgastrim and Pegfilgastrim (usually dosed once)

- GM-CSF: Sargramostim

Question 9

CSFs clinical usage

Answer 9

CA pts receiving myelosuppressive chemo, CA pts receiving BMT

Question 10

CSFs ADRs

Answer 10

• Fever
• Rash/petechiae
• Splenomegaly/splenic rupture (LUQ abd pain/left shoulder pain)
• Bone pain (lower back, posterior iliac crest, sternum)