. 2019 Jul 9:169–199. doi: 10.1007/978-3-319-74588-6_23

Table 13.

Oncologic considerations for growth factors in the ICU

Drug	Primary role in therapy	Dosing and administration	Monitoring, adverse events, and toxicities	Drug-drug interactions	Clinical pearls
Filgrastim [6]	Increase WBC	Dosing 5 mcg/kg/day IV/SQ	Monitoring CBC with differential AE/toxicities Common: fatigue, bone/joint pain, peripheral edema/capillary leak syndrome, thrombocytopenia, headache, splenomegaly Serious: ARDS, pulmonary infiltrates, splenic rupture	N/A	• Higher doses may be used during mobilization for HCT • Onset of action, 24 h • Duration: Counts return to baseline within 4 days • Do not administer within 24 h (before or after) of cytotoxic chemotherapy
Pegfilgrastim [5]	Increase WBC	Dosing 6 mg SQ once per chemotherapy cycle, beginning at least 24 h after completion of chemotherapy	Monitoring CBC with differential AE/toxicities Common: bone/joint/muscle pain Serious: ARDS, pulmonary infiltrates, splenic rupture	N/A	• Onset of action is 96 h(delayed compared to filgrastim) • Pegylated formulation allows for prolonged duration of action (half-life 15–80 h) • Do not administer within 14 days before or 24 h after cytotoxic chemotherapy
Romiplostim [3]	Increase platelets in chronic ITP	Dosing 1 mcg/kg SQ once weekly; increasing by 1 mcg/kg/week increments to achieve platelet count ≥50,000/mm³ (Max dose: 10 mcg/kg/week)	Monitoring CBC with differential AE/toxicities Common: headache, dizziness, abdominal pain, arthralgia, myalgia, increased circulating myeloblasts (MDA patients) Serious: angioedema, marrow fibrosis, VTE, hematology malignancy risk		• Onset of action between 4–9 days • Should be discontinued after 4 weeks if no response • Upon discontinuation of therapy, may see rebound thrombocytopenia and increased bleeding risk • May be used off label to increase platelet count if high risk for bleeding or for CIT

Drug

Primary role in therapy

Dosing and administration

Monitoring, adverse events, and toxicities

Drug-drug interactions

Clinical pearls

Filgrastim [6]

Increase WBC

Dosing

5 mcg/kg/day IV/SQ

Monitoring

CBC with differential

AE/toxicities

Common: fatigue, bone/joint pain, peripheral edema/capillary leak syndrome, thrombocytopenia, headache, splenomegaly

Serious: ARDS, pulmonary infiltrates, splenic rupture

N/A

• Higher doses may be used during mobilization for HCT

• Onset of action, 24 h

• Duration: Counts return to baseline within 4 days

• Do not administer within 24 h (before or after) of cytotoxic chemotherapy

Pegfilgrastim [5]

Increase WBC

Dosing

6 mg SQ once per chemotherapy cycle, beginning at least 24 h after completion of chemotherapy

Monitoring

CBC with differential

AE/toxicities

Common: bone/joint/muscle pain

Serious: ARDS, pulmonary infiltrates, splenic rupture

N/A

• Onset of action is 96 h(delayed compared to filgrastim)

• Pegylated formulation allows for prolonged duration of action (half-life 15–80 h)

• Do not administer within 14 days before or 24 h after cytotoxic chemotherapy

Romiplostim [3]

Increase platelets in chronic ITP

Dosing

1 mcg/kg SQ once weekly; increasing by 1 mcg/kg/week increments to achieve platelet count ≥50,000/mm³ (Max dose: 10 mcg/kg/week)

Monitoring

CBC with differential

AE/toxicities

Common: headache, dizziness, abdominal pain, arthralgia, myalgia, increased circulating myeloblasts (MDA patients)

Serious: angioedema, marrow fibrosis, VTE, hematology malignancy risk

• Onset of action between 4–9 days

• Should be discontinued after 4 weeks if no response

• Upon discontinuation of therapy, may see rebound thrombocytopenia and increased bleeding risk

• May be used off label to increase platelet count if high risk for bleeding or for CIT

WBC white blood cell, IV intravenous, SQ subcutaneous, CBC complete blood count, AE adverse effects, ARDS acute respiratory distress syndrome, ITP idiopathic thrombocytopenia purpura, VTE venous thromboembolism, CIT chemotherapy-induced thrombocytopenia