1. Chapter 56
Hematopoietic Agents 1

2. Hematopoietic Agents
Process by which blood cells and platelets are produced
Types
Hematopoietic growth factor
Erythropoietic (RBCs)
Leukopoietic (WBCs)
Thrombopoietic growth factor
Oprelvekin (platelets) 2

3. Erythropoietic Growth Factors
Also known as ESAs (erythropoiesis-stimulating agents)
Adverse effects
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 3

4. Epoetin Alfa (Erythropoietin)
Brand names: Epogen, Procrit
Hematopoietic growth factor
Significant effects outside hematopoietic system
Recombinant DNA technology
Uses
Anemia associated with chronic renal failure
Chemotherapy-induced anemia
For HIV-infected patients taking zidovudine
Anemia in patients facing surgery 4

5. Epoetin Alfa (Erythropoietin)
Adverse effects
Hypertension
Autoimmune pure red-cell aplasia
Very rare
Cardiovascular events
Cardiac arrest
Heart failure
Thrombotic events (stroke and MI) 5

6. Epoetin Alfa (Erythropoietin)
Warnings
Excessive dosage
Cancer patients
Renal failure patients
Preoperative patients
Risk evaluation and mitigation strategy 6

7. 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 7

8. Longer-Acting Erythropoietins
Darbepoetin alfa (long-acting)
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) 8

9. Filgrastim (Neupogen)
Granulocyte colony-stimulating factor
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 9

10. Filgrastim (Neupogen)
Uses
Cancer
Severe chronic neutropenia
Adverse effects
Bone pain
Leukocytosis 10

11. Pegfilgrastim (Granulocyte Colony-Stimulating Factor)
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 11

12. Sargramostim (Granulocyte-Macrophage Colony-Stimulating Factor)
Brand name: Leukine
Hematopoietic growth factor
Recombinant DNA technology
Uses
Adjunct to autologous bone marrow transplantation
Treatment of failed bone marrow transplants
Patients with acute myelogenous leukemia (AML)
Adverse effects
Leukocytosis
Thrombocytosis 12

13. Oprelvekin (Interleukin-11)
Brand name: Neumega
Thrombopoietic growth factor
Recombinant DNA technology
Uses
Used with myelosuppressive chemotherapy to minimize thrombocytopenia and to decrease the need for platelet transfusions
Adverse effects
Fluid retention
Cardiac dysrhythmias
Effects on the eye
Sudden death 13

14. Drugs Related to Hematopoietic Growth Factors
Romiplostim
Eltrombopag
Plerixafor

15. CAUTION
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. 15