Neutropenia

Calculate ANC rather than interpreting the neutrophil percentage alone: ANC equals total WBC count multiplied by the proportion of segmented neutrophils plus bands. A low total WBC can therefore produce severe neutropenia despite a seemingly normal relative neutrophil percentage. ScienceDirectScienceDirectLeukocyte Count - an overview

Classify ANC below 1,500/µL as neutropenia and ANC below 500/µL as severe neutropenia. Infection susceptibility rises with severity and duration; use the nadir, trend, and duration rather than a single recovered value to judge near-term risk. ScienceDirect+2ScienceDirectAbsolute Neutrophil Count - an overviewScienceDirectLeukocyte Count - an overviewScienceDirectNeutrophil Count - an overview

Treat fever or focal infection in a patient with severe neutropenia as an urgent infectious syndrome rather than waiting for etiologic classification. Chemotherapy-associated febrile neutropenia is commonly managed with broad-spectrum antibiotics and hospital admission until fever and neutropenia resolve; outpatient pathways for selected children remain limited by the absence of a fully validated clinical decision rule. Wolters Kluwer+1Wolters KluwerPredicting the risk of severe infection in... : Current Opinion in HematologyannemergmedCan We Safely Discharge Low-Risk Patients With Febrile ...

Define chronic neutropenia as persistence beyond 6 months. For an isolated low count, serial CBCs establish persistence, cyclicity, recovery, and development of additional cytopenias before labeling the condition idiopathic. ScienceDirectScienceDirectLeukocyte Count - an overview

Start with acquired causes. Medication-associated neutropenia, recent or active infection, autoimmune disease, nutritional deficiency including copper deficiency, and myeloid disorders are major acquired branches; history should specifically identify temporal drug exposure, systemic infectious symptoms, autoimmune features, dietary or malabsorptive risk, and cytotoxic therapy. ScienceDirect+1ScienceDirectAbsolute Neutrophil Count - an overviewScienceDirectNeutrophil Count - an overview

A patient with rheumatoid arthritis and neutropenia warrants directed consideration of drug-related suppression, Felty syndrome, and T-cell large granular lymphocytic leukemia; severe rheumatoid disease and immunosuppression may each contribute to the low ANC. ScienceDirectScienceDirectNeutrophil Count - an overview

Chronic idiopathic and autoimmune neutropenia are common chronic causes in both children and adults, but these diagnoses require exclusion of congenital, medication-related, systemic autoimmune, and marrow causes when the clinical pattern is atypical or infections recur. Wolters Kluwer+1Wolters KluwerAn update on the diagnosis and treatment of chronic ...Wolters KluwerThe European Guidelines on Diagnosis and... : HemaSphere

For chronic neutropenia requiring marrow evaluation, obtain bone marrow morphology, conventional cytogenetics, and next-generation sequencing of genes related to myeloid malignancies. This combination is recommended for adults with unexplained chronic neutropenia and for pediatric severe or moderate chronic neutropenia, subject to specified exceptions. Wolters KluwerWolters KluwerThe European Guidelines on Diagnosis and... : HemaSphere

Perform diagnostic marrow testing before initiating G-CSF in chronic neutropenia. This establishes a baseline and helps distinguish congenital, immune, and marrow-based disorders before treatment changes the neutrophil count. Wolters KluwerWolters KluwerThe European Guidelines on Diagnosis and... : HemaSphere

Plan annual marrow and cytogenetic follow-up for congenital bone marrow failure syndromes regardless of ANC or G-CSF treatment status. This surveillance requirement differs from stable mild isolated adult neutropenia, for which routine diagnostic marrow testing may be unnecessary. Wolters KluwerWolters KluwerThe European Guidelines on Diagnosis and... : HemaSphere

Filgrastim is indicated to reduce fever, infections, and oropharyngeal ulcers in symptomatic adult and pediatric patients with congenital, cyclic, or idiopathic severe chronic neutropenia. In the pivotal randomized trial, febrile neutropenia occurred in 40% of filgrastim-treated patients versus 76% of placebo-treated patients; severe neutropenia, hospital admission, and antibiotic-use duration were also reduced. dailymed nlm nih+2dailymed nlm nihNeupogendailymed nlm nihThese highlights do not include all the information needed to use NYPOZI safely and effectively. See full prescribing information for NYPOZI. NYPOZI (filgrastim-txid) injection, for subcutaneous or intravenous useInitial U.S. Approval: 2024 NYPOZI (filgrastim-txid) is biosimilar1 to NEUPOGEN® (filgrastim).Biosimilar means that the biological product is approved based on data demonstrating that it is highly similar to an FDA-approved biological product, known as a reference product, and that there are no clinically meaningful differences between the biosimilar product and the reference product. Biosimilarity of NYPOZI has been demonstrated for the condition(s) of use (e.g., indication(s), dosing regimen(s)), strength(s), dosage form(s), and route(s) of administration described in its Full Prescribing Informationdailymed nlm nihThese highlights do not include all the information needed to use ZARXIO safely and effectively. See full prescribing information for ZARXIO. ZARXIO® (filgrastim-sndz) injection, for subcutaneous or intravenous useInitial U.S. Approval: 2015ZARXIO (filgrastim-sndz) is biosimilar* to NEUPOGEN (filgrastim).

Chronic daily administration is required to maintain clinical benefit in severe chronic neutropenia. Individualize the dose to clinical course and ANC, with CBC monitoring used for dose adjustment. dailymed nlm nih+2dailymed nlm nihNeupogendailymed nlm nihThese highlights do not include all the information needed to use NYPOZI safely and effectively. See full prescribing information for NYPOZI. NYPOZI (filgrastim-txid) injection, for subcutaneous or intravenous useInitial U.S. Approval: 2024 NYPOZI (filgrastim-txid) is biosimilar1 to NEUPOGEN® (filgrastim).Biosimilar means that the biological product is approved based on data demonstrating that it is highly similar to an FDA-approved biological product, known as a reference product, and that there are no clinically meaningful differences between the biosimilar product and the reference product. Biosimilarity of NYPOZI has been demonstrated for the condition(s) of use (e.g., indication(s), dosing regimen(s)), strength(s), dosage form(s), and route(s) of administration described in its Full Prescribing Informationdailymed nlm nihThese highlights do not include all the information needed to use ZARXIO safely and effectively. See full prescribing information for ZARXIO. ZARXIO® (filgrastim-sndz) injection, for subcutaneous or intravenous useInitial U.S. Approval: 2015ZARXIO (filgrastim-sndz) is biosimilar* to NEUPOGEN (filgrastim).

Reported median daily filgrastim doses in postmarketing surveillance were 6 mcg/kg for congenital neutropenia, 2.1 mcg/kg for cyclic neutropenia, and 1.2 mcg/kg for idiopathic neutropenia. Rare patients with congenital neutropenia required at least 100 mcg/kg/day, illustrating the need for disease-specific dose titration rather than a fixed regimen. dailymed nlm nih+1dailymed nlm nihThese highlights do not include all the information needed to use NYPOZI safely and effectively. See full prescribing information for NYPOZI. NYPOZI (filgrastim-txid) injection, for subcutaneous or intravenous useInitial U.S. Approval: 2024 NYPOZI (filgrastim-txid) is biosimilar1 to NEUPOGEN® (filgrastim).Biosimilar means that the biological product is approved based on data demonstrating that it is highly similar to an FDA-approved biological product, known as a reference product, and that there are no clinically meaningful differences between the biosimilar product and the reference product. Biosimilarity of NYPOZI has been demonstrated for the condition(s) of use (e.g., indication(s), dosing regimen(s)), strength(s), dosage form(s), and route(s) of administration described in its Full Prescribing Informationdailymed nlm nihThese highlights do not include all the information needed to use ZARXIO safely and effectively. See full prescribing information for ZARXIO. ZARXIO® (filgrastim-sndz) injection, for subcutaneous or intravenous useInitial U.S. Approval: 2015ZARXIO (filgrastim-sndz) is biosimilar* to NEUPOGEN (filgrastim).

Recombinant G-CSF reduces chemotherapy-related neutropenia. In breast cancer treatment settings, long-acting G-CSFs are standard for primary prophylaxis against chemotherapy-induced neutropenia, and G-CSF prophylaxis may be used when febrile-neutropenia risk is high. NEJM+2NEJMReduction by Granulocyte Colony-Stimulating Factor of ...The LancetToxicity profile of antibody-drug conjugates in breast cancerThe LancetComparative efficacy and safety of four long-acting ...

Ryzneuta is an FDA-approved leukocyte growth factor for adults with nonmyeloid malignancies receiving myelosuppressive anticancer drugs associated with a clinically significant incidence of febrile neutropenia; administer one subcutaneous injection approximately 24 hours after cytotoxic chemotherapy. In metastatic breast cancer trials, cycle-1 mean duration of severe neutropenia was 1.4 days with Ryzneuta versus 4.3 days with placebo, and was noninferior to pegfilgrastim in a second study. fdafdaDrug Trials Snapshots: RYZNEUTA | FDA

For pediatric patients 1 month to younger than 17 years with nonmyeloid malignancies receiving myelosuppressive anticancer drugs associated with clinically significant febrile-neutropenia incidence, tbo-filgrastim labeling supports established safety and effectiveness; pediatric evaluation included a 5 mcg/kg/day study regimen. fda+1fdaClinical Review of PMR Report andaccessdata fdatbo-filgrastim Written Request - accessdata.fda.gov