Chapter 56
Hematopoietic Agents
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
Hematopoietic Agents
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Process by which blood cells and platelets
are produced
Types
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Hematopoietic growth factor
• Erythropoietic (RBCs)
• Leukopoietic (WBCs)
Thrombopoietic growth factor
• Oprelvekin (platelets)
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Erythropoietic Growth Factors
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Also known as ESAs (erythropoiesisstimulating agents)
Adverse effects
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Increased risk of deep vein thrombosis (DVT)
when used before elective surgery
For patients with cancer
• Can shorten time to tumor progression
• Reduce overall survival
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Epoetin Alfa (Erythropoietin)
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Brand names: Epogen, Procrit
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Hematopoietic growth factor
Significant effects outside hematopoietic system
Recombinant DNA technology
Uses
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Anemia associated with chronic renal failure
Chemotherapy-induced anemia
For HIV-infected patients taking zidovudine
Anemia in patients facing surgery
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Epoetin Alfa (Erythropoietin)
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Adverse effects
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Hypertension
Autoimmune pure red-cell aplasia
• Very rare
Cardiovascular events
• Cardiac arrest
• Hypertension
• Heart failure
• Thrombotic events (stroke and MI)
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Epoetin Alfa (Erythropoietin)

Warnings

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Excessive dosage
Cancer patients
Renal failure patients
Preoperative patients
Risk evaluation and mitigation strategy
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Epoetin Alfa (Erythropoietin)

Dosage

To minimize risks
• Use minimum needed to gradually raise hemoglobin
content to eliminate the need for RBC transfusions
• Hemoglobin level should not exceed 12 g/dL

Monitoring

Monitor hemoglobin level twice weekly
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Longer-Acting Erythropoietins

Darbepoetin alfa (long-acting)
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Similar risks and needs for monitoring as epoetin
alfa
Patients with hypertension may need increased
hypertension medications
Methoxy polyethylene glycol: epoetin beta
(very long-acting)

Not marketed in the United States (ongoing patent
dispute)
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Filgrastim (Neupogen)

Granulocyte colony-stimulating factor

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Leukopoietic growth factor
Recombinant DNA technology
Reduces the incidence of severe neutropenia
Produces dose-dependent increase in
circulating neutrophils
Reduces the incidence of infection, need for
hospitalization, and need for intravenous
antibiotics
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Filgrastim (Neupogen)

Uses
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
Cancer
Severe chronic neutropenia
Adverse effects


Bone pain
Leukocytosis
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Pegfilgrastim (Granulocyte
Colony-Stimulating Factor)
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Long-acting
Derivative of filgrastim (Neupogen)
Stimulates myeloid cells to increase
production of neutrophils
Adverse effects


Similar to filgrastim
May require opioids for pain relief
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Sargramostim (Granulocyte-Macrophage
Colony-Stimulating Factor)
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Brand name: Leukine
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Uses
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Hematopoietic growth factor
Recombinant DNA technology
Adjunct to autologous bone marrow
transplantation
Treatment of failed bone marrow transplants
Patients with acute myelogenous leukemia (AML)
Adverse effects


Leukocytosis
Thrombocytosis
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Oprelvekin (Interleukin-11)
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Brand name: Neumega


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Uses


Thrombopoietic growth factor
Recombinant DNA technology
Used with myelosuppressive chemotherapy to minimize
thrombocytopenia and to decrease the need for platelet
transfusions
Adverse effects



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Fluid retention
Cardiac dysrhythmias
Effects on the eye
Sudden death
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Drugs Related to Hematopoietic
Growth Factors
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
Romiplostim
Eltrombopag
Plerixafor
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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CAUTION
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
Epoetin alfa, filgrastim, sargramostim, and
oprelvekin stimulate proliferation of bone
marrow cells.
USE WITH GREAT CAUTION, if at all, for
patients with cancers of bone marrow origin.
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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