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Immune%20Potentiating%20Agents_2010

Immune%20Potentiating%20Agents_2010 - Objectives Immune...

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1 Immune Potentiating Agents Trinh Pham, PharmD, BCOP Associate Clinical Professor PHRX 4041 Immunology Module Objectives Students should be able to: square6 Granulocyte Colony Stimulating Factors (G-CSF) square6 Identify the indications for the use of G-CSF square6 Indicate when to administer and discontinue these agents square6 Recommend options to treat side effects square6 Interferon square6 Recognize the difference between acute and chronic side effects square6 Recommend how to manage side effects square6 Interleukine -2 (IL-2) square6 Recognize the side effects associated with IL-2 square6 Recommend appropriate agents to prevent or treat the side effects 2 hours 33 hours 3.5 hours Half-Life Stimulates granulocytes, macrophages, and eosinophils Yeast derived product Covalent conjugate of filgrastim and monomethoxy- polyethylene glycol Same MOA as G-CSF Stimulates the activation, proliferation and differentiation of neutrophil progenitor cells Enhances the function of mature neutrophils E.Coli. derived product MOA Sargramostim (Leukine ® ) (GM-CSF) Pegfilgrastim (Neulasta ® ) Filgrastim (Neupogen ® ) (G-CSF) Sargramostim Pegfilgrastim Filgrastim Bone Marrow Transplant or Acute Myelogenous Leukemia 24 hours after completion of chemotherapy Myelotoxic Chemotherapy 24 hours after completion of chemotherapy Myelotoxic Chemotherapy 24 to 72 hours after myelotoxic chemotherapy High Dose Chemotherapy with Autologous Stem Cell Rescue 24 to 120 hours after administration of high dose chemotherapy Peripheral Blood Progenitor Cell (PBPC) Mobilization Start at least 4 days before 1 st leukapheresis Non- Oncology Indications for filgrastim square6 Agranulocytosis square6 AIDS – Neutropenia square6 5-10 mcg/kg/day for 2-4 weeks square6 Myelodysplastic Syndrome (GM-CSF also indicated) square6 Neutropenic Disorders – chronic severe, symptomatic square6 Congenital - 6 mcg/kg SC twice daily square6 Idiopathic or cyclic – 5 mcg/kg/day SC Sargramostim Pegfilgrastim Filgrastim Continue until ANC is > 1.5 to 3 x 10 3 /ml for three consecutive days Once in each chemotherapy cycle Myelotoxic Chemotherapy or High Dose Chemotherapy with Autologous Stem Cell Rescue: Continue until ANC is at least 2 to 3 x 10 3 /ml or total WBC is > 5 x 10 3 /ml Peripheral Blood Progenitor Cell (PBPC) Mobilization Continue until last leukapheresis Dura- tion of Therapy
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2 1 x 10 3 /mm 3 3 10 --- --- 72 --- --- 1.4 March 14 65 --- --- % Granulocytes 1.99 x 10 3 /mm 3 --- --- --- --- 34 49 2.4 March 13 38-71 --- --- % Segs 0-10 --- --- % Bands 1.9 x 10 3 /mm 3 --- 4 12 --- 2.9 March 12 0-5 --- % Eosinophils Normal March 15 650 neutro- phil cells ANC (x 10 3 / mm 3 ) 2-15 --- % Monocytes 14-46 --- % Lymphocytes 38-81 --- % Neutrophils 4-10 1 WBC (x 10 3 / mm 3 ) Sargramostim Pegfilgrastim Filgrastim 250 mcg/m 2 /day for all clinical settings 6 mg Do not administer 14 days before and 24 hours after chemotherapy 6 mg dose should not be used in infants, children or adolescents less than 45 kg Myelotoxic Chemotherapy or High Dose Chemotherapy with Autologous Stem Cell
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