Growth Factors

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Procrit / Epogen
Starting Procrit Treatment
Procrit Side Effects
Success Rates of Procrit
Procrit Given With Other Medicines
Darbepoetin and Pegfilgrastim
Neupogen and Blast Count
Platelet Counts

Procrit / Epogen

What kind of medication is Procrit?

Procrit or Epogen are brand names for

Epoetin alfa (Epogen, Procrit) promotes red blood cell production in the bone marrow and is known as a growth factor. Growth factors are normal chemicals in the body that encourage the bone marrow to make blood cells. Growth factors have been manufactured as drugs to stimulate the bone marrow to produce more blood cells.

epoetin alfa (ih-POH-ee-tin), a man-made version of human erythropoietin (EPO). EPO is produced naturally in the body, mostly by the kidneys. It stimulates the

Soft tissue occupying the inner cavities of bones responsible for blood cell production.

bone marrow to produce

The oxygen carrying cells in our body. These bring oxygen to our tissues, and are the most numerous of the blood cells.

red blood cells. It is approved by the U.S. Food and Drug Administration (FDA) for use in patients with kidney disease. EPO has been helpful for treating

Any condition in which there are too few red blood cells in the bloodstream, resulting in insufficient oxygen to tissues and organs.

anemia in some patients with MDS, although there is still need to define more exactly which subset of patients are most likely to benefit. EPO may be helpful, but much more rarely, also in patients with aplastic anemia or PNH.

Starting Procrit Treatment

When is Procrit usually started in MDS patients?

The objective of treatment is to reduce

Any condition in which there are too few red blood cells in the bloodstream, resulting in insufficient oxygen to tissues and organs.

anemia (improve

The red blood cell protein-iron compound responsible for transporting oxygen from the lungs to the cells, and carbon dioxide from the cells to the lungs.

hemoglobin levels) or to eliminate transfusion requirements.

Erythropoietin is usually more effective in patients who are not yet transfusion-dependent. Recombinant erythropoietin, marketed as Procrit or Epogen in the U.S. (Eprex in Canada), is given as a subcutaneous (under the skin) injection usually in the upper arms, thighs or abdomen or in other sites into the soft tissue under the skin. The dosage varies greatly in different studies, 50-600 units/kg three times a week initially, then tapered for long-term use. The dose may be individualized depending on the patient's symptoms and response to the drug.

Procrit Side Effects

What are the side effects of Procrit?

The most common side effects of

Procrit for patients with cancer include: fever, diarrhea, nausea, fluid retention (edema), weakness, fatigue, high blood pressure, shortness of breath and muscle pains. Many of these same symptoms may occur in patients with the same disease who are NOT being treated with Procrit. Side effects directly related to erythropoietin (Procrit/Epogen) are uncommon, such as allergic reaction.

Success Rates of Procrit

How long have Procrit shots been used for treating anemia in myelodysplastic (MDS) patients? What is the success rate?

Epoetin alfa (Procrit or Epogen) has been used for MDS since about 1990. The benefit varies among patients. Some patients have no benefit at all. The reported response rate varies from 10-50% from study to study. Dosage for treating MDS patients with anemia should be 80,000 to 90,000 units per week, or 150-300 units per kilo per day. For patients who do not respond to adequate dosage of Epoetin, G-CSF or GM-CSF can be added (Leukine or Neupogen).

Epoetin stimulates production of young red blood cells (reticulocytes) within 3 to 7 days. A definite rise in

The red blood cell protein-iron compound responsible for transporting oxygen from the lungs to the cells, and carbon dioxide from the cells to the lungs.

hemoglobin requires longer (2-4 weeks). The maximum rise in the hemoglobin requires several months. However, in many patients with aplastic anemia the shortage of

Cells that are produced in the bone marrow and differentiate into red cells, white cells, and platelets.

stem cells is so severe that there is little left to stimulate, and EPO may work very little, if at all.

Responses to Procrit or Epogen are measured by the hemoglobin level and by monitoring the frequency of

The oxygen carrying cells in our body. These bring oxygen to our tissues, and are the most numerous of the blood cells.

red blood cells transfusions. An improved hemoglobin level is strongly correlated with less fatigue.

Patients who have relatively low serum erythropoietin levels before treatment are more likely to respond to erythropoietin. It is important for doctors to test the serum erythropoietin level in MDS patients.

Procrit Given With Other Medicines

Are other medicines given in combination with Procrit?

Procrit or Epogen is usually given alone. Low doses of Neupogen (

Filgrastim (G-CSF) and Sargramostim (GM-CSF) promote white cell growth in the bone marrow and are known as hematopoietic (blood forming) growth factors or colony stimulating factors. They are a man-made (synthetic) version of the colony stimulating factors produced naturally in your body. These drugs are prescribed "off label" for patients with MDS and other patients with low white cell counts (neutropenia).

G-CSF, granulocyte colony stimulating factor) have been reported to improve the effectiveness of Procrit, but this has not been clearly validated in a prospective randomized trial. Other medications such as amifostine or retinoic acid derivitives can be given in combination with Procrit. Procrit has little effect on the levels of other blood counts (white cells and platelets). These other counts may be improved by different medications.

Darbepoetin and Pegfilgrastim

What kind of experience is there in using darbepoetin (Aranesp) and pegfilgrastim (Neulasta) in patients with MDS?

These are longer lasting formulations of

epoetin alfa, which is used to stimulate the bone marrow to make red blood cells, and

G-CSF, which stimulates the bone marrow to make white blood cells.

Darbepoetin alfa (Aranesp) promotes red blood cell production and is known as a growth factor. Growth factors are normal chemicals in the body that encourage the bone marrow to make blood cells. Growth factors have been manufactured as drugs to stimulate the bone marrow to produce more blood cells.

Darbepoetin alfa and pegfilgrastim can be given less frequently that their counterparts. They are approved for patients undergoing cancer chemotherapy, and darbepoietin for the chronic anemia associated with renal failure. Both agents are relatively new and experience in treating

Any condition in which there are too few red blood cells in the bloodstream, resulting in insufficient oxygen to tissues and organs.

anemia due to MDS is limited. There is no reason to think that they would be more (or less) effective than the "parent" drugs (

epoetin alfa and

filgrastim).

Neupogen and blast count

Does the use of Neupogen for increasing white blood cell counts in MDS patients have a negative effect on blasts?

This is somewhat controversial. In most series there has NOT been an increased frequency or rate of developing leukemia. In theory both

Immature cells that mature into the three types of blood cells.

blast cells and normal cells can grow in response to Neupogen. Leukemia cells in specific patients may proliferate more rapidly in the presence of

G-CSF.

G-CSF (Neupogen) will often increase the percentage of circulating blasts. This effect is usually reversible. In some patients, G-CSF may decrease the percentage of blasts by inducing maturation of these cells. This effect is also usually reversible. It is not clear whether there are long-term effects of G-CSF use. A randomized trial in which neutropenic MDS patients received G-CSF or observation showed improved survival in patients who DID NOT receive G-CSF. This was because more patients in the G-CSF arm had significantly more problems with low platelets and bleeding. This may be a consequence of G-SCF therapy.

Platelet Counts

Is there a medication to improve platelet counts in aplastic anemia or MDS patients? Are there any foods or herbs to help platelet counts?

Erythropoietin is the cytokine that keeps the red blood cell series going and

G-CSF, or granulocyte colony stimulating factor, is the cytokine that helps the

Soft tissue occupying the inner cavities of bones responsible for blood cell production.

bone marrow make

An important part of our body�s defense against infection and clearing the body of harmful toxins - our immune system.

white blood cells.

Several

Hormone-like proteins secreted by many different cell types which regulate cell proliferation and function.

cytokines are being developed that may improve

The smallest cells in the blood, essential for blood clotting.

platelet counts. Although they help to decrease

A decrease in the number of platelets in the blood, resulting in the potential for increased bleeding and decreased ability for clotting.

thrombocytopenia after chemotherapy, they have not been very effective in patients with aplastic anemia or myelodysplastic syndromes. The problem with using a cytokine in someone with bone marrow failure is that the bone marrow is intrinsically disordered. The cytokine can "talk" to the bone marrow but the marrow may not be able to respond.

No foods, herbs, or supplements will improve the platelet count.