Neumega (Oprelvekin), a recombinant human interleukin (IL)-11, stimulates the proliferation of hematopoietic stem cells and megakaryocyte progenitors and induces increased platelet production through megakaryocyte maturation. NEUMEGA is indicated for the prevention of severe thrombocytopenia and the reduction of the need for platelet transfusions following
myelosuppressive chemotherapy in adult patients with nonmyeloid
malignancies who are at high risk of severe thrombocytopenia. Efficacy was demonstrated in patients who had experienced severe thrombocytopenia following the previous chemotherapy cycle.
NEUMEGA is not indicated following myeloablative chemotherapy. This means that it should not used like Neupogen, in order to enable additional chemoteherapy but only as needed to prevent bleeding or the need for platelet transfusion after chemotherapy. Severe thrombocytopenia requiring platelet transfusions is an uncommon acute problem with initiation of standard-dose chemotherapy. Nonetheless, thrombocytopenia can represent a cumulative problem with the many chemotherapeutic regimens often used to treat solid tumors, especially in patients with more heavily pretreated marrows.
Major bleeding is a rare complication related to chemotherapy-induced thrombocytopenia. Therefore, the appropriate use of thrombopoietic agents will require careful attention to several endpoints, including the need for platelet transfusions, ability to deliver chemotherapy without treatment-limiting thrombocytopenia, the safety profile of the thrombopoietic agent, and the associated health care costs.