e-learning gcsf

The Christie NHS Foundation Trust

e-learningGCSF

John Murray

Nurse Clinician BMT


Nursing Education

• Already exists• Immune thrombocytopenia• Chronic myeloid leukaemia• Adherence and compliance in CLL• Bone health in multiple myeloma• Haematopoitic stem cell mobilisation and

apheresis• GvHD video


Whose fault is it?

• The committee +1


GCSF idea

• Crystal structure


What did we want to do?

• Education• Cross borders• Be on line• Current?????• Backed by a teaching institution• Informative• Useful across countries• No one product to dominate• Test!• Validated


The Package

• What is GCSF• History• Biology• Where is it from• How does it work• Approved uses• Types of GCSF available• Instructions on use


Brief run through

• Very quick


What is GCSF?

• Name comes from discovery method• Colonies• Macrophages for.....• Granulocyte........


History

• 1983 Australia Walter and Eliza Hall Institute• Purified mouse GCSF• Groups in Japan Germany USA followed in

1986 with human clone version• 2 main companies at first• Amgen had neupogen (filgrastim) 1989• Chugai had granocyte (lenograstim) 1991


Biology

• Produced by endothelium, macrophages and other immune cells

• Exists in 2 forms• GCSF receptor present on precursor cells in BM• Response to GCSF cells proliferate and

differentiate into mature granulocytes• Potent inducer of HSC mobilisation• Main use is for

• mobilisation• decrease incidence of neutropenia


Where does GCSF come from?

• Amgen produce filgrastim by recombinant technology the human GCSF gene is inserted into an e-coli bacteria

• Although pharmacologically equivalent slight difference between e-coli produced and Chinese Hamster Ovary cell derived GCSF pharmacokinetically

• Chugai produce lenograstim by synthesis in CHO cells, makes it indistinguishable from human GCSF


How does it work?

• Binds to cell surface receptors stimulates proliferation, differentiation, commitment and end cell function


Approved uses

• UK • BCSH 2003, ASCO 2006 and NCCN guidelines• Please use own country guidance• SOP• JACIE agreed criteria for your hospital


Prophylaxis

• Primary prophylaxis• Not routinely for previously untreated patients• High risk patients 40%+ risk

• Secondary prophylaxis• Those who had febrile neutropenia with first

cycle• Adjuctive use

• Not to use routinely with antibiotics as adjunctive with uncomplicated FN <10days


With chemotherapy

• AML consolidation to reduce in pt stay• ALL to reduce severity of neutropenia• MDS reduce severity neutropenia• Aplastic trial basis only• Lymphoma to reduce incidence of infection,

chemotherapy delay and hospitalisation


Mobilisation

• Dose by weight, tables available• Mount Vernon Guidelines 2010• Chemotherapy prime + GCSF• GCSF alone• Biosimilars not recommended by EBMT 2011


How to give

• Product literature• Link to drug websites

How do I prepare my Neupogen injection?Before you inject Neupogen you must do the following:1.To avoid bending the needle, gently pull the cover from the needle without twisting as shown in pictures 1 and 2.

1.Do not touch the needle or push the plunger. You may notice a small air bubble in the pre-filled syringe. You do not have to remove the air bubble before injecting. Injecting the solution with the air bubble is harmless. 1.You can now use the pre-filled syringe. Where do I give my injection?

The best places to inject are the top of your thighs and the abdomen. If someone else is injecting you, they can also use the back of your arms.You may change the injection site if you notice the area is red or sore.


Plerixafor

• Originally for HIV• Genzyme product• Licensed for lymphoma and myeloma poor

mobilisers

Plerixafor

Dose: Plerixafor (Mozibil™) ADULT over 18 years, 240 micrograms/kg daily 6-11 hours before initiation of apheresis; usual duration 2-4 days (max. 7 days) by subcutaneous injection. Mozobil injection supplied as 1.2mL-vial

Indications•Peripheral Blood Stem Cell Mobilisation, with G-CSF in patients with Lymphoma or Myeloma

Instructions for injecting Plerixafor You will most likely receive your Plerixafor injections at your transplant center or hospital, depending on hours of operation. Plerixafor will be given to you as an injection under your skin (this is called a subcutaneous injection). A member of your healthcare team will inject the medication into a fleshy part of your body (such as your hip or leg). Plerixafor is given in combination with G-CSF. Your doses of G-CSF should be given each day starting 4 days before your first evening dose of Plerixafor and every morning you are scheduled for a session of apheresis.

Questions For You

• Why is it called Granulocyte Colony Stimulating Factor?• When and where were Granulocyte Colony Stimulating

Factor first discovered?• Who were the first 2 companies to develop a product?• Where does Granulocyte Colony Stimulating Factor

come from?• How does Granulocyte Colony Stimulating Factor work?• What are the 6 approved uses for Granulocyte Colony

Stimulating Factor?• What types of Granulocyte Colony Stimulating Factor are

available?• What are the main side effects of G-CSF?• What is Stem Cell Factor (Plerixafor™)?• How does Plerixafor™ work?• When do you use Plerixafor™?


Questions for me?

• Time to go

e-learning gcsf

Documents

gcsf cells

human gcsf gene

end cell

neupogen filgrastim

cell surface receptors

precursor cells

ecoli bacteriaalthough

cho cells