Hematopoetic agents Hematopoetics agents

Hematopoietic agents

1. Hematopoietic Agents Christopher Jiménez González PharmDc 2024

2. Understand the different hematopoietic agents available in formulary Objetives Know the indication for the different hematopoietic agents

3. Mutations to the DNA Development of abnormal cells that divide uncontrollably Cancer Myeloid Non- Myeloid Involves bone marrow cells Leukemia Does not involve bone marrow cells Sarcoma Melanoma Lymphoma

4. Cyclophosphamide Gleostine Leukuran Matulane Mitoxantrone Methotrexate Hydroxyurea Carmustine Melphalan Chlorambucil Carboplatin Doxorubicin Nitrosoureas Teniposide Mitomycin C Alemtuzumab Melphalan Paclitaxel Epirubicin Lenalidomide Irinotecan Etoposide Dacarbazine Cisplatin Ifosfamide Chemotherapies

5. Neutropenia Neutropenia ANC < 1000/mm3 Severe neutropenia ANC <500/mm3 Profound neutropenia ANC < 100/mm3 ANC WBC x % neutrophils (segs + bands) Anemia Men < 13 g/dl Women < 12 g/dL To administer chemotherapy: WBC > 3,000/mm3 or ANC > 1,500/mm3 Platelet > 100,000/mm3 Hgb > 8 g/dL

6. Hematopoietic Agents Increase the productions of blood cells WBC RBC Platelets Hbg Retacrit Zarxio Ziextenzo Promacta Leukine Hematopoietic Agents in Formulary

7. Hematopoietic Agents Retacit ® (Epoetin Alfa) Label Use Anemia due to chemotherapy in patients with cancer Anemia due to chronic kidney disease Anemia due to zidovudine in HIV-infected patients Reduction of allogeneic RBC transfusion in patients undergoing elective, noncardiac, nonvascular surgery Off label use (Consult with pharmacist) Myelodysplastic syndromes, lower-risk (symptomatic anemia management) Red blood cell transfusion refusal (substitute) Administration route SC for CKD IV Other Brand Names: Procrit, Epogen

8. Hematopoietic Agents Retacit ® (Epoetin Alfa) Problemas de Acceso (Revalidar la información con los supervisores y team leader) Se validó que, a este momento* , las siguientes presentaciones de Retacrit no están disponibles en las droguerías: Retacrit 3,000 Retacrit 20,000 Retacrit 40,000 Continua instrucción abajo brindada Retacrit 3,000, 20,000 y 40,000 unidades-   Si el medico prescribe Epogen – Se procede a evaluar según el criterio de Retacrit y si tiene la información se aprueba por excepción. Si el medico prescribe Procrit – Se procede a evaluar según el criterio de Retacrit y si tiene la información, se realiza una intervención con oficina médica para explicar y ofrecer Epogen . De no conseguir al médico se procede con la aprobación de Procrit

9. Hematopoietic Agents Zarxio ® (filgatrim) Label Use Acute myeloid leukemia following induction or c onsolidation Chemotherapy-induced myelosuppression in non-myeloid malignancies Bone Marrow Transplantation Fanconi anemia-associated neutropenia Severe chronic neutropenia Hematopoietic radiation injury syndrome, acute Off label use (Consult with pharmacist) Alcoholic hepatitis, severe Other Brand Names: Granix, Neupogen, Nivestym, Releuko

10. Hematopoietic Agents Zarxio ® (filgatrim) Off label use (Consult with pharmacist) Hematopoietic cell mobilization for autologous transplantation in patients with non-Hodgkin lymphoma of multiple myeloma Hematopoietic cell mobilization in healthy donors for peripheral blood stem cells for allogenic transplantation Myelodysplastic syndrome-associated anemia Neutropenia in advanced HIV infection Hepatitis C treatment-associated Administration route IV SC (chemotherapy induced neutropenia, peripheral blood progenitor cell collection, severe chronic neutropenia, hematopoietic radiation injury syndrome

11. Hematopoietic Agents Ziextenzo ® (pegfilgatrim) Label use Chemotherapy-induced induced neutropenia, prevention Hematopoietic radiation injury syndrome, acute Administration route SC Problemas de Acceso (Revalidar la información con los supervisores y team leader Si el medico prescribe Fulphila – Se procede a evaluar según el criterio de Ziextenso y si tiene la información se aprueba por excepción. Si el medico prescribe Neulasta – Se procede a evaluar según el criterio de Ziextenso y si tiene la información, se realiza una intervención con oficina médica para explicar y ofrecer Fulphila . De no conseguir al médico se procede con la aprobación de Neulasta . Other Brand Names: Fulphila, Fylnetra, Neulasta, Onpro, Nyvepria, Stimufend, Udenyca

12. Hematopoietic Agents Aranesp ® (darbepoetin alfa) Label use Anemia due to chemotherapy in patients with cancer Anemia due to chronic kidney disease Off label use (Consult with pharmacist) Myelodysplastic syndromes, lower risk (symptomatic anemia management) Administration route IV SC

13. Hematopoietic Agents Promacta® (eltrompobag) Label use Chronic hepatitis C-associated thrombocytopenia Immune thrombocytopenia Severe aplastic anemia, first line Severe aplastic anemia, refractory Administration route PO

14. Hematopoietic Agents Reblozyl ® (luspatercept) Label use Anemia due to beta thalassemia Anemia due to m yelodysplastic syndromes Administration route SC

15. Hematopoietic Agents Mircera ® (methoxy polyethylene glycol-epoetin beta) Label use Anemia due to chronic kidney disease Administration route IV SC

16. Hematopoietic Agents Mozobil ® (plerixafor) Label use Hematopoietic cell mobilization Administration route SC

17. Hematopoietic Agents Nplate® (romiplostim) Label use Hematopoietic syndrome of acute radiation syndrome Immune thrombocytopenia Administration route SC

18. Hematopoietic Agents Leukine ® (sargamostrim) Label use Acute myeloid leukemia, following induction chemotherapy Allogenic bone marrow transplantation, myeloid reconstitution Allogenic or autologous bone marrow transplantation, treatment of delayed neutrophil recovery or graft failure Autologous peripheral blood progenitor cell transplantation, myeloid reconstitution Autologous bone marrow transplantation, myeloid reconstitution Hematopoietic radiation injury syndrome, acute Off label use (Consult with pharmacist) Neuroblastoma (high risk), relapsed or refractory Primary prophylaxis of neutropenia in patients receiving chemotherapy o r who are at risk for neutropenic fever Administration route IV SC