Neulasta (Pegfilgrastim)  

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Neulasta (pegfilgrastim) is used to support you and your white cells during chemotherapy. This page aims to supplement the information given to you by the clinic to help you understand why Neulasta is given and what to expect. It also gives information to the district nurse who may be give you the single injection following your chemotherapy. 

For more detailed information please refer to the product information within the packet or go to the international website.

What are white cells?   Blood contains three main elements. The red cells which carry oxygen around the body from the lungs, platelets which stop us bleeding when we are cut, and white cells which help our immunity and protect us from infection. There are a number of different types of white cells but one of the most important types, are called neutrophils or granulocytes. These protect us from bacteria, which are the most likely source of infection during chemotherapy.

How does chemotherapy effect your white cells? Chemotherapy affects the rapidly dividing cells within the body.  The cells (stem cells) which make white cells are found within the bone marrow, also grow fairly rapidly and hence are often damaged by chemotherapy.  Hopefully the most rapidly dividing cells of all are those within the tumour. This is one of the reasons that chemotherapy is given in cycles, to allow the white cells to recover before the next injection. Hopefully less normal cells are killed at each cycle than tumour cells and more normal cells recover than tumour cells before the next cycle.

Sometimes too many white cells are killed and patients become susceptible to infection which can to be serious. This is most likely to happen in the middle week between cycles. If, during chemotherapy, you experience shivering or shaking attacks of fever or feel hot or unwell check your temperature. If it is raised, telephone the Hospital immediately and they will advise you. Do not take Paracetamol or Aspirin as this will bring your temperature down and mask the signs of infection. 

How does Neulasta work?   Neulasta is similar to a naturally occurring protein  which stimulates the colonies of white stem cells within the bone marrow  causing the level of neutrophils in the blood to rise (Granulocyte Colony Stimulating Factor - GCSF).   Increasing the levels of neutrophils in the blood stream reduces the risk and severity of infection. Several well conducted international studies, have proven the effectiveness of Neulasta over no medication at all or the previously commonly used white cell booster Neupogen.

When is Neulasta used? Neulasta is used to support chemotherapy to boost the white cell count. Neulasta is not often used  at the start of the first cycle of chemotherapy as in most cases it is not necessary (primary prophylaxis). The exception is "high dose" chemotherapy or when chemotherapy is given to people with a higher risk of neutropenia (e.g. the elderly or those who had previous courses of chemotherapy).  Sometimes during conventional chemotherapy too many white cells are killed and the patient develops an infection which can be serious. Neulasta is sometimes used, as well as antibiotics, to treat the infection. Firstly,  If the white cells (neutrophils) will not or are unlikely to recover by the time the next chemotherapy is due, your Oncologist has three choices:

• Delay chemotherapy
• Reduce the dose of chemotherapy
• Give Neulasta

By giving Neulasta, the chances of neutrophil recovery are increased. This would allow scheduled chemotherapy to be given as planned and prevent unnecessary chemotherapy delays and dose reductions.

How should Neulasta be given?  Neulasta is given as an injection under the skin (subcutaneous), the usual dose is one 6mg of pegfilgrastim in a pre-filled syringe. The ways in which it is given vary from doctor to doctor and department to department. The most common way is approximately 24 hours after the last dose of chemotherapy. Some patients learn to inject themselves (see tips on how to inject yourself) but in others, your chemotherapy nurse will arrange a district nurse to give it.

Possible side effects Neulasta is generally well tolerated and it is often difficult to separate the mild side effects from those caused by the chemotherapy. Even so, occasional side effects can occur and these are mentioned below.  It is rarely possible to develop side effects not mentioned here.

• It is common to have aching bones and joints for 2-3 days duration starting 1-2 days after the start of the injections. This is usually mild and is caused by the bone marrow working harder to produce more white cells. Occasionally it is more troublesome and pain killers are required. (Provided you don't have a temperature paracetamol is often helpful. If it is not strong enough ask your doctor about a slightly stronger analgesic. Remember if you feel unwell check your temperature before you due to take your next pain killers).
• Occasionally irritation at the injection site.
• Rarely - Mild flu like symptom,  headache, malaise, rigors & nausea.
• Rarely - Mild itching and occasional skin rash.

These last two symptoms are caused by a mild allergic-like reaction. They can usually be corrected next time by a small dose of oral steroids or antihistamines taken just before your Neulasta injection.

Manufactured by: Amgen Manufacturing, Limited, a subsidiary of Amgen Inc. One Amgen Center Drive, Thousand Oaks, California 91320-1799.  Download the full PDF version of Patient Product Information (PDF, 173 Kb)