Use of Neupogen in CLL

CLL is the acronym for Chronic Lymphatic Leukemia. It is a form of cancer in which there is uncontrolled growth of B-lymphocytes, a white blood cell important to the functioning of the immune system. In CLL, the cancer cells tend to accumulate in the blood and bone marrow, but are also found in the lymph nodes. CLL is a slow-growing cancer and treatment may not start immediately upon diagnosis, but may be reserved until a particular stage of the disease is reached.

Complication Management

• There are four stages of CLL and not all physicians initiate treatment at the same stage. However, treatment typically consists of chemotherapy and possible radiation therapy. Treatment is not cancer cell specific. As a result, the amount of other, normal blood cells may be reduced. Neutropenia is the reduction in the number of circulating neutrophils. Neutrophils fight infectious agents which enter the blood. Development of neutropenia causes increased susceptibility to infections. Neupogen, also known by its generic name filgrastrim, is a man-made form of granulocyte colony-stimulating factor (G-CSF) which is responsible for initiating growth of the neutrophils. It is used to reverse neutropenia occurring during CLL treatment. The goal is to bolster an already compromised immune system. It is given as an injection into the fatty layer of the skin.

Stem Cell Transplantation

• Stem cell transplantation is being used as a treatment, possibly curative, modality in CLL. An allogenic stem cell transplant involves the infusion of stem cells from a donor. This is preferred over an autologous (self) transplant in that the donor cells do not have leukemia. Donor cells also seem to fight the leukemia cells. Stem cell transplantation may cause CLL to go into remission. However, there is always the chance for recurrence of the leukemia. Donor white blood cells are being used to fight the recurrence of cancer cells with the hope of inducing another remission. The Shands Cancer Center at the University of Florida, reports that use of Neupogen appears to have a similar effect on recurring leukemia as does the use of donor white blood cells. Neupogen has fewer potential complications than donor white blood cells; the most important being no graft-versus-host disease.