Transfusion medicine handbook

8. Clinical Alternatives and Applications

8.3 Haematopoietic Growth Factors

Genetically engineered haematopoietic growth factors are expected to have an increasing impact on the use of allogeneic blood components. These should only be used by clinicians with relevant expertise.

Recombinant Human Erythropoietin (r-HuEPO)

• Epoetin alfa - EPREX, Binocrit
• Epoetin beta - NeoRecormon

Administration of r-HuEPO can increase the rate of red cell production, principally through its proliferative effect on erythroid precursors.

EPREX and Binocrit have the following indications [4] [5]:

• The treatment of severe anaemia of renal origin accompanied by clinical symptoms in patients with renal insufficiency not yet undergoing dialysis.
• Anaemia associated with chronic renal failure in paediatric and adult patients on dialysis.
• Anaemia in patients with non-myeloid malignancies where anaemia is due to the effect of concomitantly administered chemotherapy, and where blood transfusion is not considered appropriate.
• Adult patients with mild-to-moderate anaemia (haemoglobin > 100 to < 130g/L) scheduled for elective surgery with an expected moderate blood loss (2-4 units or 900 to 1800mL) to reduce exposure to allogeneic blood transfusion and to facilitate erythropoietic recovery.
• To augment autologous blood collection and to limit the decline in haemoglobin in anaemic adult patients undergoing major surgery who are not expected to pre-deposit their complete peri-operative blood needs.

NeoRecormon is indicated for [6]:

• Treatment of Anaemia in Patients with Chronic Kidney Disease
• Treatment for Increasing the Amount of Autologous Blood
• Prevention of Anaemia of Prematurity
• Treatment of Anaemia in Patients with Non-Myeloid Malignancies

Granulocyte-Colony Stimulating Factor (G-CSF)

• Filgrastim - Zarzio, Neupogen, Nivestim
• Pegfilgrastim – Neulastim, Pelgraz
• Lenograstim - Granocyte

G-CSF is accepted therapy in the management of patients with severe neutropenia associated with chemotherapy-induced bone marrow failure, autoimmune and drug-induced disorders, congenital agranulocytosis and to increase the level of haematopoietic progenitor cells (HPC) in the circulation prior to collection by apheresis for autologous and allogeneic HPC transplantation.

CXCR4 Chemokine Receptor Antagonist

• Plerixafor - Mozobil

Plerixafor, an antagonist of the CXCR4 chemokine receptor, is used in combination with G-CSF to enhance mobilisation of haematopoietic stem cells in adult patients with myeloma and lymphoma whose cells mobilise poorly.

Thrombopoietin Receptor Agonist

• Eltrombopag - Revolade

Eltrombopag binds to the thrombopoietin receptor (TPO-R) inducing proliferation and differentiation of megakaryocytes with subsequent platelet production.

Revolade is indicated for the treatment of adult patients with [7]:

• Immune thrombocytopenia (ITP) who have had an inadequate response or are intolerant to corticosteroids and immunoglobulins
• Thrombocytopenia in patients with chronic hepatitis C to allow the initiation and maintenance of interferon-based therapy
• Severe aplastic anaemia (SAA) who have had an insufficient response to immunosuppressive therapy (refractory SAA).