To mobilize PBSC after myelosuppressive chemotherapy – 0.5 million units, starting on the first day buy testosterone cypionate after completion of chemotherapy and as long as the number of neutrophils can not pass through the expected minimum and reaches normal values. Leukapheresis be carried out during the period when. Patients not receiving intensive chemotherapy, one leukapheresis is enough. In some cases, it is recommended to conduct additional leukapheresis.
PBSC mobilization in healthy donors for allogeneic transplantation
For 1 million units (10 micrograms) / kg per day n / k for 4-5 days. Leukapheresis was carried out 5 days and, if appropriate up to 6 days to obtain CD34 + ≥ 4 x 106 cells / kg body weight of the recipient.Efficacy and safety of Neupogen ® to mobilize PBSC healthy donors younger than 16 and older than 60 years have not been studied.
Severe chronic neutropenia (TXH)
Daily, n / a, once or divided into multiple administrations. In congenital neutropenia: the initial dose – 1.2 million units (12 micrograms) / kg per day; idiopathic neutropenia or intermittent: 0.5 million units (5 micrograms) / kg per day to a stable excess neutrophil 1.5 x 10 9 / L. After achieving a therapeutic effect should be to determine the minimum effective dose to maintain this level. To maintain the desired number of neutrophils requires prolonged daily administration. After 1-2 weeks of treatment, depending on the patient response to therapy, the starting dose can be doubled or halved. Subsequently, every 1-2 weeks can produce individual dose adjustment to maintain the number of neutrophils in the range of 1.5-10 × 10 9 / L. Patients with severe infections scheme can be applied with more rapid increase in dose.In 97% of patients responded positively to treatment, the full therapeutic effect is observed at doses up to 24 mg / kg per day. Safety prolonged administration Neupogen ® at doses greater than 24 mg / kg per day in patients with TXH not installed.
Use in children – see “Features of the application of the drug in pregnant women, women during the period of breastfeeding, children and adults with chronic diseases.”.
Neutropenia in HIV infection
The initial dose of 0.1-0.4 million IU (4.1 mg) / kg once a day n / k to achieve and to maintain a normal neutrophil count (more than 2.0 x 10 9 / L). In more than 90% of patients responded positively to treatment, the normalization of the number of neutrophils usually occurs within 2 days. A small number of patients (10% less) to achieve the required normal number of neutrophils administering doses to 1.0 million IU (10 micrograms) / kg per day (maximum daily dose of less than 10 mg / kg). After achieving a therapeutic effect requires the introduction of the minimum effective dose to maintain a normal number of neutrophils. The recommended maintenance dose is 300 micrograms a day n / k on average 3 times a week, alternating pattern (every other day). Subsequently, the individual may require dose adjustment and long-term use of the drug to maintain the average neutrophil count> 2.0 x 10 9 / L.
Specific guidance on dosing
Recommendations for dosing in special patient groups refer to “Features of the application of the drug in pregnant women, women during the period of breastfeeding, children and adults with chronic diseases.”
Instructions for dilution
Neupogen ® diluted only 5% glucose solution. When this is not permitted dilution of 0.9% sodium chloride solution. It introduced the drug to a final concentration of less than 1 5 micrograms per ml.
If Neupogen ® diluted to a concentration of at least 1.5 MU (15 ug) in 1 ml, the solution should be added to human serum albumin in an amount that the final concentration of albumin was 2 mg / ml. For example, in a final volume of 20 ml, the total dose filgrastim less than 30 million units (300 micrograms) to be administered with the addition of 0.2 ml of 20% albumin solution.
Divorced can adsorb to glass and plastics. However, at a dilution of 5% glucose solution is compatible with glass and some plastics, including polyvinyl chloride, polyolefin (a copolymer of polypropylene and polyethylene) and polypropylene.
Ready solution is stored at a temperature between 2 and 8 ° C for up to a day.
Treatment with Neupogen ® should only be done under the supervision of an oncologist or hematologist with experience in the use of G-CSF, with the necessary diagnostic capabilities. Mobilization and apheresis procedures should be performed in cell oncology or hematology center with experience in this field and the possibility of adequate monitoring of hematopoietic progenitor cells.
a) The growth of malignant cells
The safety and efficacy of Neupogen ® in patients with myelodysplastic syndrome or chronic myelogenous leukemia have not been established, so it is not shown in these diseases. Particular attention should be paid to the differential diagnosis between acute myeloid leukemia and blast crisis of chronic myeloid leukemia.
Human G-CSF can promote growth of myeloid cells in vitro. Similar effects can be observed in vitro and in relation to certain non-myeloid cells.
It should be used with caution in patients with secondary AML, due to the limited data on the safety and efficacy in this case.
The safety and efficacy of buy testosterone cypionate in patients with acute myeloid leukemia de novo under the age of 55 years in case of favorable cytogenetic prognostic factors (translocation t (8; 21), t (15; 17), inv (16)) have not been established.
b) Patients receiving cytotoxic chemotherapy
Leukocytosis: less than 5% of patients receiving at doses more than 0.3 million units (3 mg / kg per day), the number of leukocytes was increased to 100 x 10 9 / L or more. There were no adverse events directly related with leukocytosis, not described. However, given the potential risks associated with high leukocytosis, during treatment with should regularly (eg, 2-3 times a week) to determine the number of leukocytes. If, after passing the expected minimum number of leukocytes than 50 x 10 9 / L, should be discontinued immediately. If N used to mobilize PBSC, the dose should be reduced or completely canceled in the case where the number of cells exceeds 70 x 10 9 / L.
The risk associated with high-dose chemotherapy: particular caution should be exercised when treating patients receiving high-dose chemotherapy, because improved outcome of cancer were observed, while the chemotherapeutic agents higher doses have a more severe toxicity, including skin reactions and side effects to the cardiovascular , nervous and respiratory systems (see. the instructions for use of specific chemotherapeutic agents).
Monotherapy drug buy testosterone cypionate does not prevent anemia and thrombocytopenia caused by myelosuppressive chemotherapy. Because of the potential application of higher doses of chemotherapy (eg full doses in accordance with the schemes), the patient may be at greater risk of thrombocytopenia and anemia. It is recommended to conduct regular blood tests and to determine platelet count and hematocrit.Particular caution should be exercised when using single-component or combination chemotherapeutic regimens known to cause severe thrombocytopenia.
It has been shown that the use of Neupogen ® to mobilize PBSC reduces the extent and duration of thrombocytopenia, which developed as a result of myelosuppressive or myeloablative chemotherapy.
c) Patients with TXH
Transformation to leukemia or predleykoz (myelodysplastic syndrome): particular caution should be exercised in diagnosing TXH, and differentiate it from other hematologic disorders such as aplastic anemia, myelodysplasia, and myeloid leukemia. Prior to treatment should be carried out a detailed analysis of blood with determination of leukocyte and platelet counts, as well as to explore the morphological picture of the bone marrow and karyotype.
A small number (3%) of patients with severe congenital neutropenia (Kostmann’s syndrome) treated with, observed myelodysplastic syndrome and leukemia. Myelodysplastic syndrome and leukemia – natural complications of the disease. Their connection with the treatment of drug unclear. Approximately 12% of patients with normal cytogenetics when re-examination detected abnormalities, including monosomy 7. If a patient with the syndrome Kostmann appear cytogenetic violations, it is necessary to carefully evaluate the benefits and risks of continuing therapy with. With the development of myelodysplastic syndrome or leukemia should be discontinued. It is not yet clear whether long-term treatment predisposes drug in patients with severe congenital neutropenia (Kostmann’s syndrome) to the development of cytogenetic abnormalities, myelodysplastic syndrome and leukemia. Patients with the syndrome Kostmann is recommended at regular intervals (approximately every 12 months.) To carry out the morphological and cytogenetic studies of bone marrow.
Cytogenetic disorders, leukemia and osteoporosis have been found long-term use of the drug Neupogen ® (> 5 years) patients (9.1%) with TXH. Communication of these phenomena with the use of the drug is not clear.
Blood formula: you need to carefully monitor the number of platelets, especially during the first few weeks of treatment with buy testosterone cypionate . shop steroids tamoxifen citrate for sale steroidwithdrawal.biz