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Published in Vilius Savickas, Reem Kayyali, Neel Sharma, Student Success in the Prescribing Safety Assessment (PSA), 2020
Vilius Savickas, Reem Kayyali, Neel Sharma
Mrs O’Neill, an 81-year-old lady, is admitted to hospital with a suspected chest infection and diarrhoea. Blood investigations demonstrate neutropenia. Stool cultures for Clostridium difficile are negative. Mrs O’Neill is put on piperacillin/tazobactam 4.5 g IV QDS and gentamicin 150 mg IV OD for suspected neutropenic sepsis. She is also prescribed an adequate fluid regimen and 3 days of lenograstim 263 micrograms SC. PMH: rheumatoid arthritis, dementia, recurrent UTIsDH: methotrexate 20 mg weekly, co-codamol 30/500 T-TT PRN QDS, donepezil 5 mg ON, trimethoprim 100 mg ONSH: a widow living in Surrey; weight: 49 kg; height: 156 cm
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Published in Caroline Ashley, Aileen Dunleavy, John Cunningham, The Renal Drug Handbook, 2018
Caroline Ashley, Aileen Dunleavy, John Cunningham
Lenograstim is primarily eliminated by the kidney and neutrophils/neutrophil precursors; the latter presumably involves binding of the growth factor to the G-CSF receptor on the cell surface, internalisation of the growth factor-receptor complexes via endocytosis, and subsequent degradation inside the cells. During chemotherapy-induced neutropenia, the clearance of lenograstim is significantly reduced and the concentration of lenograstim is sustained until onset of neutrophil recovery.
Saprochaete clavata Chorioretinitis in a Post-chemotherapy Immunocompromised 9-Year-Old Child
Published in Ocular Immunology and Inflammation, 2023
Paul Goupillou, Damien Costa, Gilles Gargala, Loic Favennec, Claire Rouzaud, Marc Muraine, Pascale Schneider, Julie Gueudry
A type 2 acute myeloid leukaemia had been discovered 3 months earlier and the patient received chemotherapy treatment. Induction treatment consisted of mitoxantrone, cytarabine, and gemtuzumab. During the consolidation treatment involving cytarabine and fludarabine, he received empirical antibacterial therapy and caspofungin for septic shock. Blood culture was positive for Saprochaete clavate (Figure 1) and caspofungin was switched to liposomal amphotericin B (L-AmB). There was no other case in the paediatric department. Cerebrospinal fluid culture was also positive for Saprochaete clavata. Antifungal susceptibility assays showed good sensitivity to voriconazole (VCZ), L-Amb and flucytosine (5-FC) with minimal inhibitory concentrations (MIC) of 0.032, 0.38 and 0.032 μg/mL, respectively. Brain magnetic resonance imaging (MRI) and thoraco-abdominal computed tomography (CT) revealed secondary localisations with brain, liver, splenic and lung lesions. Lenograstim was introduced and aplasia ended a few days later.
Colony stimulating factors for prophylaxis of chemotherapy-induced neutropenia in children
Published in Expert Review of Clinical Pharmacology, 2022
In addition, the efficacy of GM-CSFs (sargramostim) was not studied in pediatric cancer patients for primary prophylaxis of febrile neutropenia. Since there are data that sargramostim and filgrastim may be therapeutically equivalent, further studies to evaluate its use in the pediatric population may be beneficial. In addition, there are novel G-CSFs that are not approved in US yet. For example, Lonquex (lipegfilgrastim) is a glycopegylated, long-acting form of filgrastim which may offer an alternative long-acting agent [43]. In elderly patients with B-NHL, lipegfilgrastim demonstrated non-inferiority compared to pegfilgrastim for reducing the duration of severe neutropenia [44]. Lenograstim is another G-CSF agent that is not yet approved by US FDA. A 2020 French study concluded that the efficacy and safety profile of lenograstim was indistinguishable from that of filgrastim for the treatment of chronic neutropenia [45]. More clinical trials on the use of these agents may aid a better understanding of G-CSFs and provide more treatment options for pediatric patients with cancer.
Advances in the pharmacological management of neutropenia in solid tumors: the advent of biosimilars
Published in Expert Opinion on Pharmacotherapy, 2021
Michele Ghidini, Alice Indini, Olga Nigro, Simona Polito, Erika Rijavec, Fausto Petrelli, Gianluca Tomasello
Lenograstim (LENO, Granocyte®, Chugai pharmaceutical Co.) unlike FIL and PEG, is a glycosylated recombinant form of G-CSF [43]. It represents a valid alternative to FIL in management of neutropenia of patients receiving myeloablative treatments [44]. Glycosylation increases the receptor affinity of the protein to the corresponding receptor, creates a higher plasma half-life and confers temperature resistance (no need for refrigeration) [45]. Similarly, to FIL, the dose of LENO is patient-specific, is calculated based on body weight and administered daily until neutrophil counts recover [46]. In outpatient treatment setting, such goal is achieved after an average of 5–6 days for LENO [43] while, for some patients, a longer duration of G-CSF has been prescribed (maximum of 10–11 days) [46,47] However, in a systematic review comparing LENO with FIL, no reason to prefer LENO in any of the approved indications was identified [48].