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Aetna considers combinational use of G-CSF filgrastim Neupogenfilgrastim-sndz Zarxiotbo-filgrastim Granix or pegfilgrastim Neulastapegfilgrastim-jmdb Fulphilaor GM-CSF sargramostim Leukine or using more than one product during any one chemotherapy cycle experimental and investigational because the effectiveness of this approach has not been established.
Combination use of sargramostim with a filgrastim product for the mobilization of hematopoietic progenitor cells in the autologous setting is considered medically necessary. The administration of pegfilgrastim Neulasta or pegfilgrastim-jmdb Fulphila with weekly chemotherapy regimens is considered experimental and investigational.
Standard practice in protecting against chemotherapy-associated infection has been chemotherapy dose modification or dose delay, administration of progenitor-cell support, or selective use of prophylactic antibiotics.
Chemotherapy associated neutropenic fever or infection has customarily involved treatment with intravenous antibiotics, usually accompanied by hospitalization. The hematopoietic colony-stimulating factors CSFs have been introduced into clinical practice as additional supportive measures that can reduce the likelihood of neutropenic complications due to chemotherapy.
Despite these benefits, CSFs are not administered to all patients receiving myelosuppressive chemotherapy because of the costs associated with their routine use. The definition of patients at high risk for severe or febrile neutropenia is outlined in ASCO guidelines referenced in this policy.
CSFs also have a place in therapy for many other types of neutropenia, bone marrow transplant, as well as for building up of white blood cells in peripheral blood progenitor cell PBPC transplantation.
Post bone marrow transplant, the patient must recover their white blood cells for higher quality of life as they are often isolated due to their weakened immune system during the transplant process.
Radiation therapy can also weaken the immune system substantially, causing neutropenia. Colony-stimulating factors are recommended in some situations, e. Colony-stimulating factors are also effective in the mobilization of peripheral-blood progenitor cells.
Therapeutic initiation of CSFs in addition to antibiotics at the onset of FN should be reserved for patients at high risk for septic complications.
Use of CSFs in patients with myelodysplastic syndromes may be reasonable if they are experiencing neutropenic infections. Administration of CSFs after initial chemotherapy for acute myeloid leukemia does not appear to be detrimental, but clinical benefit has been variable and caution is advised.
Available data support use of CSFs in pediatric cancer patients similar to that recommended for adult patients. Colony-stimulating factors should not be used concurrently with chemotherapy and radiation, or to support increasing dose-dense chemotherapy regimens.
In the absence of chemotherapy, therapeutic use of CSFs may be considered in patients receiving radiation therapy alone if prolonged delays secondary to neutropenia are expected.
Efficacy studies of Neupogen filgrastim could not be conducted in humans with acute radiation syndrome for ethical and feasibility reasons. Approval of this indication was based on efficacy studies conducted in animals and data supporting the use of Neupogen filgrastim for other approved indications.
Filgrastim is available as Neupogen mcg and mcg vials and as mcg and mcg prefilled syringes. In adult cancer patients receiving myelosuppressive chemotherapy or induction and consolidation therapy for acute myeloid leukemia, the U. Neupogen filgrastim should not be administered earlier than 24 hours after cytotoxic chemotherapy or within 24 hours before chemotherapy.
The first dose should be administered at least 24 hours after cytotoxic chemotherapy or after bone marrow infusion. Chronic daily administration is required to maintain clinical benefit.
Absolute neutrophil count should not be used as the sole indication of efficacy. Administer as soon as possible after suspected or confirmed exposure to radiation doses greater than 2 gray Gy.
Other than for peripheral blood progenitor cell re-infusion, CSFs should be administered subcutaneously or intravenously no earlier than 24 hours and preferably between 24 and 72 hours after the administration of cytotoxic chemotherapy to provide optimal neutrophil recovery.Clinical Journal of Oncology Nursing • Volume 10, Number 2 • Oncology Nursing This is called febrile neutropenia and is de-ﬁ .
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Pamela Hallquist Viale, RN, MS, CNS, ANP. As a member of the American Society of Clinical Oncology (ASCO), I occasionally receive emails containing requests for survey participation. Introduction. OPAT (outpatient parenteral antimicrobial therapy) is a care modality that allows patients to receive intravenous antibiotics in their own homes or in an outpatient setting.
Warnings and Precautions • FOLOTYN may suppress bone marrow function, manifested by thrombocytopenia, neutropenia, and anemia. Monitor blood counts and omit and/or reduce dose for hematologic toxicities.
Nursing Care Plan FEBRILE NEUTROPENIA Febrile neutropenia is defined as a neutrophil count It is a life-threatening condition, requiring prompt treatment and close monitoring to prevent septic shock • Record TPR, BP and oxygen saturation on admission using the Track & Trigger.
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