Neutropenia

How are Patients with Neutropenia Treated?

Most patients with neutropenia develop fever and are treated with antibiotics. Additionally, several new drugs called granulocyte colony stimulating factors may stimulate the growth of neutrophils. Two of these growth factors that stimulate production of white blood cells in the bone marrow are the granulocyte-macrophage colony stimulating factor (GM-CSF, generic name sargramostim, brand name Leukine) and granulocyte colony stimulating factor (G-CSF, generic name filgrastim, brand name Neupogen). Neutropenic patients may take these growth factors after they receive myelosuppressive chemotherapy (therapy to halt the production of blood cells in the bone marrow) for up to two weeks. Growth factors are usually administered by nurses when the patient is in the hospital, but patients (or their family members) may learn how to give themselves these injections at home.

According to Amgen, the manufacturer of Neupogen, patients with neutopenia should avoid:

• Contact with people who have colds or infections
• Situations where a bruise or break to the skin may result
• Immunization shots unless the patient’s physician approves
• Squeezing pimples
• Any new medications unless the patient’s physician approves
• Fingernail cuts or tears
• Cuts with sharp objects⁽¹⁾

Health care professionals will monitor a patient’s red and white blood cells counts during chemotherapy. If a patient’s white blood cell count becomes very low, a patient may have to stop chemotherapy and take growth factors to raise his/her cell count. Occasionally, physicians may prescribe growth factors as prophylatic (preventive) treatment to avoid low white blood cell counts.

A new drug called Neulasta (generic name, pegfilgrastim) is also now available from Amgen. It is a longer lasting form of G-CSF which patients only need to receive once per chemotherapy cycle, typically 24 hours after the cycle has been administered.

Additional Types of Neutropenia

Neutropenia is most common during or after a patient receives chemotherapy to treat cancer. However, according to the Neutropenia Support Association, there are several rare types of neutropenia that may affect both adults and children.

Types of neutropenia:

• Chronic congenital neutropenia: a rare inherited type of neutropenia that affect children more often than adults. Symptoms include frequent fevers, mouth sores, ear infections, pneumonia, or rectal sores. If untreated, many children may lose their teeth or develop severe gum infections. The most severe form of chronic congenital neutropenia is called Kostmann's Syndrome.
• Cyclic neutropenia: occurs in both children and adults and is often present in several members of the same family. Cyclic neutropenia tends to occur every three weeks and last three to six days at a time. Symptoms include fever, illness, and mouth ulcers. Children with cyclic neutropenia usually improve after puberty.
• Chronic idiopathic neutropenia: is a rare form of neutropenia that may result in life-threatening infections.⁽²⁾

Additional Resources and References

• (1) Amgen, the manufacturer of the drug Neupogen, provides detailed information on neutropenia at http://www.neupogen.com/
• (2) http://www.neutropenia.ca/ The Neutropenia Support Association Inc. is a registered charity formed in 1989 to increase awareness and understanding of neutropenia. The association provides assistance to neutropenic patients and their families and also raises money for research and education.
• For information on Leukine, please visit the website at http://www.leukine.com/
• For information on the drug Neulasta, manufactured by Amgen, please visit http://www.neulasta.com/
• For additional information on chemotherapy, please visit http://www.imaginis.com/breasthealth/chemo.asp
• The American Cancer Society provides information on neutropenia at http://www.cancer.org

Updated: November 16, 2007

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