Author: V. Dimov, M.D., Cleveland Clinic
A 40 yo AAM with end-stage HIV/AIDS has a WBC of 1.66, ANC 498, Hgb 13.7, platelets 61.
Hypertension, HIV, h/o esophageal candidiasis, h/o HZV face
Acyclovir, doxycycline, esomeprazole, azithromycin, dapsone, Truvada, Norvir, Atazanavir
Neutropenia and thrombocytopenia in AIDS
ID suggests starting G-CSF. Which one should you choose? Neulasta or Neupogen?
Neupogen is FDA-approved for use in AIDS neutropenia. It is given daily and the effect can be titrated, e.g. the administration can be stopped when the desired effect is achieved (ANC >1000 x3 days). Neulasta is given just once, in a single dose. In chemotherapy-induced neutropenia, a single dose of Neulasta is as effective as 16 doses of Neupogen.
In the patient described above, Neupogen is a better choice.
Granulocyte Colony-Stimulating Factor (G-CSF) is a glycoprotein growth factor which stimulates bone marrow to produce granulocytes. The recombinant human G-CSF synthesised in an E. coli expression system is called filgrastim. Filgrastim (Neupogen®) and PEG-filgrastim (Neulasta®) are two commercially-available forms of rhG-CSF (recombinant human G-CSF). The PEG (polyethylene glycol) form has a much longer half-life, reducing the necessity of daily injections (modified from source: Wikipedia).
Neupogen (Epocrates link)
1-10 mcg/kg SC qd
Check CBC baseline and 2x/wk; may D/C if ANC >1000 x3 days.
Neulasta (Epocrates link)
6 mg SC x1
Monitor CBC, plt
The patient was evaluated by Hematology/Oncology who also recommeded treatment with Neupogen. ANC improved with Neupogen, the patient was asymptomatic and was discharged home with ID follow-up.
Final diagnosis: AIDS-related neutropenia
Recombinant granulocyte colony-stimulating factor in the long-term treatment of AIDS-related neutropenias. Recenti Prog Med. 1993 Jul-Aug;84(7-8):526-30.