Neutropenia

A study has found no evidence that bleomycin plus granulocyte-stimulating factor (G-CSF) increases the risk for bleomycin-induced pulmonary toxicity in patients with Hodgkin lymphoma.

Although researchers observed improvements when incorporating several new comorbidities into chemotherapy-induced febrile neutropenia risk factors, the improvements were small and might not be clinically relevant.

Patients with acute myeloid leukemia (AML) and febrile neutropenia that are de-escalated on day 5 if they were afebrile, hemodynamically stable, and without evidence of infection, had similar clinical outcomes and a decreased incidence of Clostridium difficile infections compared with patients without these early on re-evaluations for de-escalation.

A second biosimilar to Amgen’s Neupogen, which treats neutropenia, has been approved in the United States. The FDA approved Pfizer’s filgrastim-aafi, which will be sold under the brand name Nivestym. Zarxio (filgrastim-sndz) was the first filgrastim biosimilar approved by the FDA in 2015.

Management of pediatric oncology patients with febrile neutropenia and hospitalization duration currently vary by institution and by provider. A poster presented at the 59th American Society of Hematology Annual Meeting reviewed pediatric hematology/oncology patients who were admitted with febrile neutropenia to determine discharge and release, as well as subsequent readmission within the next 4 days.

Febrile neutropenia (FN) is among the most serious clinical complications in patients with cancer who are undergoing chemotherapy. Patients with neutropenia, or low neutrophil counts, are predisposed to serious and life-threatening infections because of their immune system’s impaired ability to mount inflammatory responses to bacteria, fungi, and yeast.1,2 Because fever is often the only sign of infection in these patients, the presence of both fever and neutropenia must be treated as a medical emergency.2,3 Despite advances in treatment and prevention, mortality rates in patients with cancer and FN can range from 5% to 20%. Higher mortality rates are associated with patients who have higher occurrences of infectious complications and more comorbidities.3 Although there are slightly varying definitions of FN, most clinical guidelines follow the definitions set forth by the Infectious Diseases Society of America (IDSA).4,5 The IDSA defines fever as a single oral temperature ≥38.3°C (101°F) or a temperature ≥38.0°C (100.4°F) lasting more than 1 hour, and defines neutropenia as an absolute neutrophil count (ANC)

Annual spending on biologic medications has been on the rise. It is estimated that biologic drugs, defined as complex, protein-based, large-molecule compounds designed to treat complicated disease states, accounted for $200 billion to $210 billion of global spending on medicines in 2016.1,2 With such rises in healthcare spending, it is important to consider the economic implications and potential of adopting effective cost-saving measures wherever possible. Biosimilars can offer an opportunity in terms of cost-saving potential, with an estimated potential of $44.2 billion in savings in biologic drug spending in the United States from 2014 to 2024.3 The cost savings could ultimately provide huge benefits to patients, healthcare providers, and all payers involved in the healthcare system, which is especially important in an era of rapidly rising healthcare costs.3 A biosimilar is a biological product that is approved for use based on chemical, molecular, and structural similarities to an already approved biological drug, known as the reference drug or originator product.2 According to the FDA, a biosimilar must show no clinically significant differences in its efficacy and safety profile in comparison with its reference product.4 The introduction of biosimilars into the pharmaceutical market has lowered medication costs while also allowing expanded » patient access to new treatments.5 One example in which the economic and facilitative impact of biosimilars can be seen is the granulocyte colony-stimulating factor (G-CSF) market; there were notable changes in the cost and accessibility of the medication class after the introduction of biosimilars.

Based on long-term observations, granulocyte colony-stimulating factor utilization is a safe and effective treatment to prevent infections and improve quality of life in patients with cyclic neutropenia, according to an analysis in The New England Journal of Medicine.

Physicians caring for patients with severe congenital neutropenia should be ready to detect issues with multiple systems in the body, explained Seth Corey, MD, of the Virginia Commonwealth University and the Massey Cancer Center & Children's Hospital of Richmond, during a session at the 59th American Society of Hematology Annual Meeting and Exposition in Atlanta, Georgia.

For the most part, it’s well known that eating healthy and in moderation is more beneficial to our health. In 2017, there were a number of news stories that drove that knowledge home.

There are no clinically meaningful differences in the safety profile of B12019 and pegfilgrastim, according to study findings presented at the American Society of Hematology’s 59th Annual Meeting and Exposition in Atlanta, Georgia.

In a session at the 59th American Society of Hematology Annual Meeting and Exposition in Atlanta, Georgia, Brian Curtis, PhD, of the BloodCenter of Wisconsin Blood Research Institute, highlighted drugs other than chemotherapy that may cause neutropenia in patients.

Including the modified brentuximab antibody in the treatment regimen improved modified progression-free survival by 5%, although the rates of neutropenia and infections were higher in patients administered the brentuximab-containing regimen.

A study published in the Journal of Managed Care & Specialty Pharmacy found that filgrastim and filgrastim-sndz were noninferior for the prevention of febrile neutropenia events that would require hospitalization. However, inferiority could not be established for serious adverse events.

For high-risk patients with hematological malignancies and febrile neutropenia, empirical antimicrobial therapy can be discontinued after 72 hours of apryexia and clinical recovery regardless of their neutrophil count, according to a study in The Lancet Hematology. The traditional approach of continuing the initial regimen of EAT in neutropenic patients with unexplained fever until neutrophil recovery could result in unnecessarily prolonged EAT.

With the increasing emergence of less expensive biologic alternatives, some health systems are making the switch. For a large healthcare system, the arrival of a cheaper alternative to filgrastim prompted the conversion to using tbo-filgrastim as the preferrred granulocyte-colony stimulating factor. The results were shared in a study published by the Journal of Managed Care & Specialty Pharmacy.

In an interview with The American Journal of Managed Care®, Kashyap Patel, MD, Carolina Blood and Cancer Care, discussed risk factors that contribute to the development of neutropenia, how to minimize the risk of development, the effects of neutropenia, and what he recommends to patients who have been treated for the condition.

David Dale, MD, professor, internal medicine, University of Washington Medical Center, dicusess diagnosing neutropenia and its symptoms; the causes of neutropenia; when neutropenia becomes dangerous and requires hospitalization; and the costs associated with neutropenia in an interview with The American Journal of Managed Care®.

A recent abstract presented at the American Society of Clinical Oncology (ASCO) annual meeting compared 2 risk models for patients with intermediate chemotherapy-induced neutropenia (CIN) risk and compared them to guidelines from ASCO and the National Comprehensive Cancer Network to determine when colony-stimulating factor should be ideally used to prevent CIN. ​​​​​​

The University of Illinois aimed to improve the time to antibiotic adminstration for patients with febrile neutropenia by implementing a new standard operative protocol.

Cyclin-dependent kinase 4/6 inhibitors may have proven benefits for treating metastatic breast cancer, but the therapies are associated with hematological toxicities and febrile neutropenia.

Recently reported results from Hydroxyurea Study of Long-Term Effects (HUSTLE) support the use of hydroxyurea in children, and indicate that a preferred dosing strategy should target an HbF endpoint of greater than 20%.

A new collaboration between PathoQuest and Memorial Sloan Kettering Cancer Center (MSK) will test the best method to identify microorganisms responsible for infections in patients with febrile neutropenia.

While it is known that febrile neutropenia is the most common reason for pediatric patients with cancer visiting the emergency department (ED), little had been known about the most common reasons for adult patients with cancer ending up in the ED.

In a pair of interviews, experts discuss neutropenia resulting from treatment of metastatic breast cancer with CDK4/6 inhibitors.

Strong chemotherapy may be part of the treatment plan for patients diagnosed with cancer, but it also comes with risks. A new campaign will empower patients with cancer to better understand and navigate risks such as febrile neutropenia that are associated with strong chemotherapy.