NCCN, ASCO and ASH guidelines recommend routine use of Neulasta® or Neupogen (filgrastim) for patients with an overall risk of FN of 20% or greater. Previous studies have suggested that these drugs can reduce the incidence of hospitalizations, decrease Febrile Neutropenia and allow better delivery of protocol doses of chemotherapy. The supportive data was generated from 8 randomized clinical trials and 3 observational studies conducted between 1998 and 2005.
NEUPOGEN® (filgrastim) is indicated to decrease the incidence of infection‚ as manifested by febrile neutropenia‚ in patients with nonmyeloid malignancies receiving myelosuppressive anti- cancer drugs associated with a significant incidence of severe neutropenia with fever , as dose dense chemotherapy for lymphoma would be. The recommended starting dose of NEUPOGEN® (filgrastim) is 5 mcg/kg/day‚ administered as a single daily injection by SC bolus injection‚ by short IV infusion (15 to 30 minutes)‚ or by continuous SC or continuous IV infusion. A CBC and platelet count should be obtained before instituting NEUPOGEN® (filgrastim) therapy‚ and monitored twice weekly during therapy. Doses may be increased in increments of 5 mcg/kg for each chemotherapy cycle‚ according to the duration and severity of the ANC nadir.
Whereas 10 days of therapy may be, in fact, necessary, the indication is for doses to be adjusted based on ANC and WBC. SImilaryl, NCCN on MGF-C says that Neupogen should be used until nadir recoveryu and does not state a defined number of doses.