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Exam 1
Lecture 12 part 2- nuetropenia and mucositis
69
Anthropology
4th Grade
01/28/2014

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Term
ANC equation-
Definition
{(%neutrophila +%bands) xWBX]/100
Term
ANC between 1000 to 1500
Definition
mild neutropenia
Term
500
Definition
moderate neutropenia
Term
AND <500
Definition
severe neutropenia
Term
the degree of neutropenia shows your-
Definition
risk of infection
Term
chemo induced neutropenia depdns on what factors?-4
Definition
type of chemoc
pretreatment
presence of cancer in bone marrow
age
Term
what is the most common DOSE LIMITNG tox of chemo?
Definition
neutropenia/infection (morbidity and mortality)
Term
most chemo cause nadir btwn days-
recovery by day
Definition
7-14
21
Term
nadir is wen?
Definition
there is lowest amnt of neutrophils
Term
consequuences of neutropenia is increased-3
Definition
infx, ANX, hospitlization
Term
conseq. of neutropenia is compromised-
Definition
tx effiacy due to dose decreases
Term
to prevent neutropeniawhat two things cna be done
Definition
dose reeduction
hematooeotic growth factors (CSF)
Term
For tx of neutropenia, what 3 things are done
Definition
hospitlization
ABX if febrile
hematopeotic growth factors
Term
the G-CSF (gnulocytte stim factor) is 3 things-3
Definition
glycoportine
growth factor
cytokine
Term
G-CSF is normally produce by?
Definition
macrophages/immune cells
Term
G-CSF recpt is on bone marrow, if stimualted what can it do-2
Definition
proliferation of granulocuytes
bone marrow cell rlease
Term
G-CSF signal pathway invovles what molcules-3
Definition
JACK/STAT
RAS/MAPK
PI3K/Protein kinase B (Akt)
Term
_ G CSF stimulates rpoduction of neutrophuls
Definition
filgrastim (and pegylates form pregrilgrastim)
Term
_ G cSF stimulates myelopoeisis
Definition
sagramostim
Term
G CSF is used for-2
Definition
psot chemo febrile nuetropenia
post inducer of hematopeotic stem cells for stem cell trnasplantation
Term
G CSf is used for chemo febril enutropenia when-3
Definition
risk is 20% and no other regimen
doesnt compromise dose intensity
reduces dose delya
Term
G CSF is sued in primary prophylaxis when-
Definition
POSt -CT before neutropenia
Term
G CSF is used as secdonary prophylaxis when-
Definition
post CT pt with previeoius neutropenia from CT
Term
Use primary prohpylaxis G CSF when:
CT and risk of FN >20%
Definition
always
Term
Use primary prohpylaxis G CSF when:
CT and risk of FN 10-20%
Definition
use if other risk factors (age, hx, etc)
Term
Use primary prohpylaxis G CSF when:
CT and risk of FN <10%
Definition
Never (only if complications start)
Term
when is C-CSF agents used after chemo?
Definition
24 hrs post chemo
Term
filgrastim is dosed how mnay times per day and howmnay days?
how long does a dose last?
Definition
daily x7-14 d
24 hrs
Term
filgrastim is for inpt/outpt
which med is for the other?
Definition
inpatient
pegylated is for outpat
Term
Pegylated filgrastim is dosed how much?
Definition
1 dose x 2 weeks
Term
Sargromostim us used when?
Definition
after BM tnrasplant if pt has fungal infx
Term
indications fo G CSF-4
Definition
post chemo as primary prevetnion of FN
chronic neutropenia
stem cell trnaspl
pierpiheral mobilization
Term
sargamostim is only indicated in pediatrics/adults after _ indcution therapy
Definition
adults
AML
Term
Filgrastim dosing
how admin?
max if <132 lbs, if >?
Definition
5 mcg/kg per day
SQ
300, 480
Term
Dosing pegfilgrastim
admin?
Definition
6mg
SC per chemo cycle
Term
whcih G CSf has longest half life
Definition
Pegfilgrastim
Term
dosing of Sargramostim
admin?
Definition
250 mcg/m^2
SC
Term
Serioes ADES of G CSFs-4
Definition
sickel cell
anaphylaxis
resp
splenic rupture
Term
Chemo Tx with high risk for nuetropenia:-6
Definition
(Non- Hgokins CHOP, ICe, RICE)
cyclophosphamide, etoposide, cisplatin, paclitexal +cisplatin,
topotecan
Taxane +dox +/- cyclpphos
Term
clincial pearls about G CSFs-
are admin _ chemo
no change in infx/overall omrtality w/?
which is better?
Definition
24 hrs post
treat,ent
prevention!
Term
what is proimary issue with G CSFs?
Definition
COST
Term
mucositis can occur-6
Definition
esophagus, duodenum, ileum, colon, rectum, stomach
Term
what is mucosistis-
Definition
infalmm of mucus surfaces in body
Term
what disease invovles red ulcerative sores?
Definition
mucosistis
Term
oral mucosisits manifests as-3
Definition
erythemia, ulcers, hemorrhage
Term
mucosisits is damage to_ of what places
why?
Definition
epitheloum
GI, oralpharyngeal
chemo affects the rapid dividing cells of muscus
Term
Muscosistis Phase 1
Definition
DNA damage thru chemo
Term
Muscosistis Phase 2
Definition
signaling with messengers
Term
Muscosistis Phase 3
Definition
amplificaiton of apopotosis/bacterium invades
Term
Muscosistis Phase 4
Definition
fungus invades/ulceration
Term
Muscosistis Phase 5
Definition
healing
Term
oral mucosists is most common* *also more aggreive in this one
Definition
Term
*can get nasal and vaginal mucosistis
Definition
Term
Grade _ mucosists:

painless ulcers, mild soreness
Definition
1
Term
Grade _ mucosists:
painrful esema or ulvers but eating possible
Definition
2
Term
Grade _ mucosists:
painful edema/ulcers, require IV eating
Definition
3
Term
Grade _ mucosists:
severe ulcers requiring TPN or intubaiton for feeds
Definition
4
Term
symtpoms of mucosists-4
Definition
pain
diff eating
adb pain
diarrhea
Term
complicaitons of mucosistis-3
Definition
bactermia/sepsis
poor nutrition
decrease activty/QOL
Term
what class of agnets are used to tx mucosistis
Definition
keratinocyte growth factor (KGF)
Term
MOA of KGF-4
Definition
decrease DNA damage
increase detox enzyme to protect from ROS
decrease pro inflamm cytokines
decrease apoptosis
Term
KGF doesnt have evidence for use in what-2
why?
Definition
chemo only regimens
solid tumors
may increase tumor growth
Term
KGF jas indicaitons for us in-3
Definition
hametologic malignancy
high dose chemo + total body irridation
stem cell trnasplant
Term
Palifermin (Kepivance) is-
Definition
recombinant KGF
Term
palifermin dose
Definition
60 mcg/kg/day x 3 day before
and smae x 3 days after
Term
palifermin is admin
Definition
IV bolus
Term
plaifermin shoundlnt be admin _ chemo
Definition
24 hrs before, during, or after meyelotoxic
Term
palifermin is contradinciated ni what person
Definition
allergic to E. coli protein
Term
ADEs of palifermin-3
Definition
thick tongue/discolor
taste disturbance
amylase/lipase elevation
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