Other hematologic pharmacotherapies

Question 1

Epogen is considered a _____

Answer 1

Colony Stimulating Factor (CSF)

Question 2

Erythropoietin (Epogen) MOA

Answer 2

Stimulates erythroid progenitor (Proerythroblast) division and
differentiation, stimulating erythropoiesis

Question 3

Erythropoietin (Epogen) Indications

Answer 3

○ Anemia of Chronic Kidney Disease
○ HIV-Associated Anemia
○ Chemotherapy-Related Anemia
○ To reduce need for surgery-associated transfusion

Question 4

Erythropoietin (Epogen) contraindications

Answer 4

○ Hypersensitivity to mammal-derived proteins/albumin
○ Neonates or infants - benzyl alcohol forms
○ Uncontrolled hypertension
○ Caution if cardiovascular disease, CABG surgery, or stroke

Question 5

Erythropoietin (Epogen) side effects

Answer 5

○ Nausea, vomiting
○ Hypertension
○ Cough
○ Pruritus
○ Rash
○ Headache
○ Arthralgias
○ Fatigue
○ Edema

Question 6

Erythropoietin (Epogen) Adverse reactions

Answer 6

○ Thromboembolism
○ Myocardial Infarction
○ Stroke
○ CHF Exacerbation
○ Seizures
○ Severe hypertension
○ Pure Red Cell Aplasia

Question 7

Erythropoietin (Epogen) BBWs

Answer 7

○ Increased mortality and serious cardiovascular events, MI, stroke,
VTE when target Hgb is greater than 11 g/dL in CKD patients
○ Increased mortality and/or tumor progression in cancer patients.
Use only in chemo-related anemia when cancer cure is not
anticipated
○ Increased incidence of thromboembolic events in surgical
patients. If need to give, consider concomitant DVT prophylaxis

Question 8

Erythropoietin (Epogen) Follow up

Answer 8

○ Check BP, Ferritin, and TIBC at baseline, then periodically
○ Check Hgb weekly and adjust PRN until stable, then check Hgb
monthly
○ Benefits probably outweigh unexpected risk during
pregnancy/lactation

Question 9

____ is considered a Granulocyte Colony Stimulating
Factor (G-CSF)

Answer 9

Neupogen

Question 10

Filgrastim (Neupogen) MOA

Answer 10

Binds to receptors on
hematopoietic stem cells,
influencing and increasing the
production of neutrophils

Question 11

Filgrastim (Neupogen) indications

Answer 11

○ Post-Chemotherapy Neutropenia-induced myelosuppression
○ Post-Bone Marrow Transplant Neutropenia
○ Peripheral Blood Progenitor Cell (PBPC) Mobilization
○ Severe, chronic Neutropenia (congenital or idiopathic)
○ Hematopoietic Syndrome of Radiation - counter the myelosuppressive
radiation
○ AIDS-Associated Neutropenia

Question 12

Filgrastim (Neupogen) contraindications

Answer 12

○ Hypersensitivity to E. coli proteins
○ If within 24 hours of chemotherapy or radiation treatment
○ Caution if sickle cell disease, myelodysplasia, or myeloid cancer

Question 13

Filgrastim (Neupogen) adverse reactions

Answer 13

○ Splenic rupture
○ Acute Respiratory Distress
Syndrome (ARDS)
○ Thrombocytopenia
○ Anaphylaxis
○ Glomerulonephritis
○ AML or Myelodysplastic
Syndrome occurring in patients
with congenital neutropenia

Question 14

Filgrastim (Neupogen) follow up

Answer 14

○ For post-chemotherapy, post-BMT, and post-radiation neutropenia
patients, CBC with diff 3 times per week
○ For severe, chronic neutropenia patients, CBC with diff 2 times per week
for first 4 weeks, then monthly for 1st year, then every 3 months
thereafter
■ Also, bone marrow evaluation annually if congenital neutropenia
○ Benefits likely outweigh risks during pregnancy; Risk of fetal harm is low
based on human data
○ Lactation safety is unknown, caution advised. Consider avoiding
breastfeeding till >3 days after DC

Question 15

_____ is considered an Colony Stimulating Factor (CSF)

Answer 15

Leukine

Question 16

Sargramostim (Leukine) MOA

Answer 16

Stimulates proliferation and
differentiation of
granulocytes and
macrophages

Question 17

Sargramostim (Leukine) indications

Answer 17

○ Post-Chemotherapy Neutropenia-induced myelosuppression
○ Post-Bone Marrow Transplant Neutropenia
○ Peripheral Blood Progenitor Cell (PBPC) Mobilization
○ Severe or Chronic Neutropenia (congenital or idiopathic)
○ Hematopoietic Syndrome of Radiation
○ AIDS-Associated Neutropenia

Question 18

Sargramostim (Leukine) contraindications

Answer 18

○ If circulation of Leukemic Myeloid blasts is greater than 10%
○ Concurrent chemotherapy or radiation therapy w/in 24 hours
○ Caution if pericardial effusion, arrhythmias, or CHF
○ Potential for antibody development against the drug

Question 19

Sargramostim (Leukine) side effects

Answer 19

○ Abdominal pain (89%)
○ Diarrhea (89%)
○ Fever (81%)

Question 20

Sargramostim (Leukine) adverse reactions

Answer 20

○ Severe asthenia
○ Pleural effusion
○ Pericardial effusion

Question 21

Sargramostim (Leukine) follow up

Answer 21

○ Monitor respiratory status during and right after infusion
○ Check CBC with diff at baseline and then 2 times per week
○ BUN/Creatinine should be checked at least every other week if
the patient has renal impairment
○ LFTs should be checked at least every other week if the patient
has hepatic impairment

Question 22

What is the “Caution: Benzyl Alcohol” about?

Answer 22

● Some manufacturers of Epogen and Leukine have used Benzyl Alcohol as a
preservative
● The low dose seems to be harmless to adults, but is known to be harmful to
neonates – Benzyl Alcohol Toxicity
● Caution/contraindications for Epogen and Leukine
○ If the vial contains Benzyl Alcohol as a
preservative, the medication should not be
administered to infants, pregnant women, or
breastfeeding mothers