Neupogen is often used to mobilize hematopoietic progenitor cells into the peripheral blood for collection by leukophereses for members who are undergoing peripheral blood progenitor cell”. It is FDA approved: “NEUPOGEN® (filgrastim) is indicated for the mobilization of hematopoietic progenitor cells into the peripheral blood for collection by leukapheresis. Mobilization allows for the collection of increased numbers of progenitor cells capable of engraftment compared with collection by leukapheresis without mobilization or bone marrow harvest. After myeloablative chemotherapy‚ the transplantation of an increased number of progenitor cells can lead to more rapid engraftment‚ which may result in a decreased need for supportive care”.
The recommended dose of NEUPOGEN® (filgrastim) for the mobilization of PBPC is 10 mcg/kg/day SC‚ either as a bolus or a continuous infusion. It is recommended that NEUPOGEN® (filgrastim) be given for at least 4 days before the first leukapheresis procedure and continued until the last leukapheresis. This The FDA says, “Although the optimal duration of NEUPOGEN® (filgrastim) administration and leukapheresis schedule have not been established‚ administration of NEUPOGEN® (filgrastim) for 6 to 7 days with leukaphereses on days 5‚ 6‚ and 7 was found to be safe and effective (see Clinical Experience for schedules used in clinical trials). Neutrophil counts should be monitored after 4 days of NEUPOGEN® (filgrastim) ‚ and NEUPOGEN® (filgrastim) dose modification should be considered for those patients who develop a WBC count > 100‚000/mm3.” In none of the studies listed in the Clinical Experience section, was Neupogen used for 14 days for stem cell mobilization.
Clinical studies have used longer administrations, for example, Ria et al, used a 12 day schedule. Nevertheless, the FDA approved dose and schdule are the most common and and there seems to be little reason to prefer a longer schdule.
Bassi Simona et a, A single dose of Pegfilgrastim versus daily Filgrastim to evaluate the mobilization and the engraftment of autologous peripheral hematopoietic progenitors in malignant lymphoma patients candidate for high-dose chemotherapy. Transfusion and Apheresis Science Volume 43, Issue 3 , Pages 321-326, December 2010
Tricot G, Barlogie B, Zangari M, van Rhee F, Hoering A, Szymonifka J, et al. Mobilization of peripheral blood stem cells in myeloma with either pegfilgrastim or filgrastim following chemotherapy. Haematological. 2008;93:1739–1742
R Ria et al, Comparison between filgrastim and lenograstim plus chemotherapy for mobilization of PBPCsBone Marrow Transplantation (2010) 45, 277–281