Transcript John Murray

e-learning
GCSF
John Murray
Nurse Clinician BMT
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Nursing Education
• Already exists
• Immune thrombocytopenia
• Chronic myeloid leukaemia
• Adherence and compliance in CLL
• Bone health in multiple myeloma
• Haematopoitic stem cell mobilisation and
apheresis
• GvHD video
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Whose fault is it?
• The committee +1
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GCSF idea
• Crystal structure
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What did we want to do?
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Education
Cross borders
Be on line
Current?????
Backed by a teaching institution
Informative
Useful across countries
No one product to dominate
Test!
Validated
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The Package
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What is GCSF
History
Biology
Where is it from
How does it work
Approved uses
Types of GCSF available
Instructions on use
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Brief run through
• Very quick
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What is GCSF?
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Name comes from discovery method
Colonies
Macrophages for.....
Granulocyte........
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History
• 1983 Australia Walter and Eliza Hall Institute
• Purified mouse GCSF
• Groups in Japan Germany USA followed in 1986
with human clone version
• 2 main companies at first
• Amgen had neupogen (filgrastim) 1989
• Chugai had granocyte (lenograstim) 1991
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Biology
• Produced by endothelium, macrophages and
other immune cells
• Exists in 2 forms
• GCSF receptor present on precursor cells in BM
• Response to GCSF cells proliferate and
differentiate into mature granulocytes
• Potent inducer of HSC mobilisation
• Main use is for
• mobilisation
• decrease incidence of neutropenia
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Where does GCSF come from?
• Amgen produce filgrastim by recombinant
technology the human GCSF gene is inserted
into an e-coli bacteria
• Although pharmacologically equivalent slight
difference between e-coli produced and Chinese
Hamster Ovary cell derived GCSF
pharmacokinetically
• Chugai produce lenograstim by synthesis in
CHO cells, makes it indistinguishable from
human GCSF
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How does it work?
• Binds to cell surface receptors stimulates
proliferation, differentiation, commitment and
end cell function
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Approved uses
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UK
BCSH 2003, ASCO 2006 and NCCN guidelines
Please use own country guidance
SOP
JACIE agreed criteria for your hospital
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Prophylaxis
• Primary prophylaxis
• Not routinely for previously untreated patients
• High risk patients 40%+ risk
• Secondary prophylaxis
• Those who had febrile neutropenia with first
cycle
• Adjuctive use
• Not to use routinely with antibiotics as
adjunctive with uncomplicated FN <10days
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With chemotherapy
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AML consolidation to reduce in pt stay
ALL to reduce severity of neutropenia
MDS reduce severity neutropenia
Aplastic trial basis only
Lymphoma to reduce incidence of infection,
chemotherapy delay and hospitalisation
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Mobilisation
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Dose by weight, tables available
Mount Vernon Guidelines 2010
Chemotherapy prime + GCSF
GCSF alone
Biosimilars not recommended by EBMT 2011
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How to give
• Product literature
• Link to drug websites
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How do I prepare my Neupogen injection?
Before you inject Neupogen you must do the following:
1.To avoid bending the needle, gently pull the cover from the needle without twisting as shown in pictures 1 and 2.
1.Do not touch the needle or push the plunger.
You may notice a small air bubble in the pre-filled syringe.
You do not have to remove the air bubble before injecting. Injecting the solution with the air bubble is harmless.
1.You can now use the pre-filled syringe.
Where do I give my injection?
The best places to inject are the top of your thighs and the abdomen. If someone else is injecting you, they can also use the back of your arms.
You may change the injection site if you notice the area is red or sore.
Plerixafor
• Originally for HIV
• Genzyme product
• Licensed for lymphoma and myeloma poor
mobilisers
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Plerixafor
Dose: Plerixafor (Mozibil™) ADULT over 18 years, 240 micrograms/kg daily 6-11 hours
before initiation of apheresis; usual duration 2-4 days (max. 7 days) by subcutaneous
injection. Mozobil injection supplied as 1.2mL-vial
Indications
•Peripheral Blood Stem Cell Mobilisation, with G-CSF in patients with Lymphoma or Myeloma
Instructions for injecting Plerixafor
You will most likely receive your Plerixafor injections at your transplant center or hospital, depending on hours of operation.
Plerixafor will be given to you as an injection under your skin (this is called a subcutaneous injection).
A member of your healthcare team will inject the medication into a fleshy part of your body (such as your hip or leg).
Plerixafor is given in combination with G-CSF. Your doses of G-CSF should be given each day starting 4 days before your first
evening dose of Plerixafor and every morning you are scheduled for a session of apheresis.
Questions For You
• Why is it called Granulocyte Colony Stimulating Factor?
• When and where were Granulocyte Colony Stimulating
Factor first discovered?
• Who were the first 2 companies to develop a product?
• Where does Granulocyte Colony Stimulating Factor
come from?
• How does Granulocyte Colony Stimulating Factor work?
• What are the 6 approved uses for Granulocyte Colony
Stimulating Factor?
• What types of Granulocyte Colony Stimulating Factor are
available?
• What are the main side effects of G-CSF?
• What is Stem Cell Factor (Plerixafor™)?
• How does Plerixafor™ work?
• When do you use Plerixafor™?
Questions for me?
• Time to go
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