Neutropenia
Methods of Managing Cancer Related Neutropenia

Hematopoietic Growth Factors (Growth Factors)
Growth factors are a medication that is given either as a shot into your subcutaneous fat or into a vein through an IV. Growth factors are special proteins that can stimulate the bone marrow to produce more white blood cells, red blood cells or even platelets. They work like your own body does when it is healthy and normal. The white blood cell growth factors are used to prevent neutropenia in non-myeloid malignancies after certain kinds of chemotherapy. They can also be used to prepare patients to donate or harvest stem cells prior to stem cell transplant and to help patients recover after stem cell transplant. Red blood cell growth factors are used to help patients recover from anemia (low red blood cell count).

Examples of growth factors for White Blood cells are G-CSF (granulocyte colony stimulating factor), GM-CSF (granulocyte-macrophage colony stimulating factor) and IL3 (interleukin 3). Scientists are investigating different uses for these growth factors in clinical trials. They are not used for every patient and only indicated in certain settings. There are different drugs with differing properties available (trade names Neupogen^® and Neulasta^®).

Filgrastim (Neupogen^®) and pegfilgrastim (Neulasta^®) are the growth factors most often used for neutropenia and have been found to be safe and effective. Filgrastim is rapidly cleared from the body through the kidneys and requires daily administration up to 14 days. Pegfilgrastim is a pegylated form of filgrastim. This medication has been developed by adding a molecule (polyethylene glycol molecule) which gives the medication an extended half-life making it possible to give one single dose per chemotherapy cycle. Talk to your doctor about these medications to determine which if any is the best for you.

Side Effects of Growth Factors

Side effects often vary from one person to another. The most common side effects reported with growth factors are bone pain, which may be a dull ache or discomfort in the bones of the back, arms, legs or hips. This can often be relieved with acetaminophen. The pain or discomfort is usually mild and goes away once the injection or injections are completed. Sometimes the skin around the injection site can become red or itchy but this will disappear once the injection(s) are complete. Fever and chills can occur with some growth factors and you need to tell your doctor or nurse if you experience any side effects.

Neutropenic Fever

If fever develops while you are neutropenic you need to seek immediate medical attention. It could be life-threatening and should be taken very seriously. A variety of tests will need to be done to determine the source of your infection. They may include (but are not limited to) the following: urine culture, blood cultures from your arms (and from a central line if you have one) chest x-ray, and a physical exam. Broad spectrum antibiotics should be started as soon as possible.

Special Considerations
Research is being conducted that will help doctors determine when to use growth factor support. Primary treatment with growth factors may be warranted in patients that have risk factors for infections. These risk factors may include but are not limited to, history of febrile neutropenia, advanced disease, preexisting neutropenia due to disease, extensive previous chemotherapy or previous radiation therapy to the pelvis or other areas containing large amounts of bone marrow, inability to care for self, decrease in immune function, current infections or wounds.

For many patients, it is very important to receive the intended dose of chemotherapy on time in order to have the best chance at survival. Growth factor support may be warranted to help patient achieve this. If the setting is not curative, doctors may recommend decreasing the dose of chemotherapy.