Neutropenia

Question 1

Neutropenia is characterised by a low neutrophil count (absolute neutrophil count less than ____________)

Answer 1

1.5 x 10^9/litre

Question 2

Neutropenia is a risk factor for the development of ______________, especially in patients receiving high-intensity chemotherapy regimens

Answer 2

infection and sepsis

Question 3

Neutropenia is a risk factor for the development of infection and sepsis, especially in patients receiving _______________

Answer 3

high-intensity chemotherapy regimens

Question 4

___________________ stimulates the production of neutrophils and may reduce the duration of chemotherapy-induced neutropenia and thereby reduce the incidence of associated febrile neutropenia

Answer 4

Recombinant human granulocyte-colony stimulating factor (rhG-CSF); there is as yet no evidence that it improves overall survival

Question 5

Granulocyte-colony stimulating factors include … (4)

Answer 5

Drugs ending in “grastim” ie GRAnulocyte STIMulating factors

1. filgrastim
2. lenograstim
3. pegfilgrastim
4. lipegfilgrastim

Question 6

Pegfilgrastim and lipegfilgrastim are polyethylene glycol-conjugated (‘___________’) derivatives of filgrastim, which are longer-acting forms of filgrastim due to decreased renal clearance

Answer 6

pegylated

Question 7

Pegfilgrastim and lipegfilgrastim are polyethylene glycol-conjugated (‘pegylated’) derivatives of filgrastim, which are ___________-acting forms of filgrastim due to ____________

Answer 7

longer

decreased renal clearance

Question 8

_____________ (unglycosylated rhG-CSF) and _____________ (glycosylated rhG-CSF) have similar effects; both have been used in a variety of clinical settings for the treatment of neutropenia

Answer 8

Filgrastim

lenograstim

Question 9

How are granulocyte-colony stimulating factors (G-CSF) administered?

Answer 9

S/C

Question 10

GCS-Fs should be prescribed with caution in which patients? (4)

Answer 10

1. Malignant myeloid conditions
2. Pre-malignant myeloid conditions
3. Risk of splenomegaly and rupture spleen size should be monitored)
4. Sickle-cell disease

Question 11

GCS-F stimulates the production of ____________

Answer 11

Neutrophils

Question 12

Following the administration of GCS-F, there have been reports of pulmonary infiltrates leading to ________________—patients with a recent history of pulmonary infiltrates or pneumonia may be at higher risk.

Answer 12

acute respiratory distress syndrome

Question 13

Following the administration of GCS-F, there have been reports of pulmonary infiltrates leading to acute respiratory distress syndrome—patients with a recent history of ________________ or ________________ may be at higher risk.

Answer 13

pulmonary infiltrates

pneumonia

Question 14

Patients who have been on filgrastim for more than 6 months should be monitored for _________________

Answer 14

Osteoporotic bone disease; monitor bone density

Question 15

Common side effects of GCS-Fs include … (10)

Answer 15

1. Arthralgia, osteoporosis
2. Cutaneous vasculitis
3. Dyspnea
4. Hemoptysis, hemorrhage
5. Headache
6. Hypersensitivity, rash
7. Leukocytosis
8. Pain
9. Spleen abnormalities and hepatomegaly
10. Thrombocytopenia

Question 16

Treatment with GCS-F should be withdrawn in patients who develop signs of ______________

Answer 16

pulmonary infiltration

Question 17

Are GCS-F drugs safe to use in pregnancy and breastfeeding?

Answer 17

Avoid during both

Question 18

What are the monitoring requirements for patients taking GCS-F drugs? (2)

Answer 18

1. FBC should be monitored including differential WCC and PLT counts
2. Spleen size should be monitored during treatment due to risk of splenomegaly and rupture

*plus regular morphological and cytogenetic bone marrow examinations in severe congenital neutropenia due to possible risk of myelodysplastic syndromes and leukemia

Question 19

Patients with severe congenital neutropenia who are taking filgrastim are at an increased risk of developing ______________ or ______________

Answer 19

Myelodysplastic syndrome

Leukemia

Question 20

GCS-F drugs are contraindicated in patients with ________________ or ______________

Answer 20

Severe congenital neutropenia who develop leukemia

Have evidence of leukemic evolution