Clinical Challenges

Pegfilgrastim-Induced Pain in Patients With Lymphoma

Ellen C. Mullen

acute care, ambulatory care and office nursing, clinical practice, chemotherapy, leukemia, lymphomas, and hematology
ONF 2014, 41(2), 212-214. DOI: 10.1188/14.ONF.212-214

A 56-year-old Caucasian woman named Ms. P was diagnosed with diffuse large-cell lymphoma with aggressive features. Her presenting symptoms included fever, weight loss, and drenching night sweats, with disease present in mesenteric, inguinal, and axillary lymph nodes as well as in her bone marrow. Ms. P has multiple comorbidities including diabetes, hypertension, gout, osteoarthritis, and hyperlipidemia. Ms. P presented to the clinic to discuss treatment options. Her oncologist recommended chemotherapy with rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (R+EPOCH) for six cycles with intrathecal chemotherapy prophylaxis and pegfilgrastim support. Ms. P agreed with the treatment plan and was admitted to receive chemotherapy. She tolerated the treatment well without any significant side effects or adverse events. She was discharged and returned to clinic after 24 hours to receive the pegfilgrastim.

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    References

    Kirshner, J., Heckler, C., Janelsins, M., Dakhil, S., Hopkins, J., Coles, C., & Morrow, G. (2012). Prevention of pegfilgrastim-induced bone pain: A phase III double-blind placebo-controlled randomized clinical trial to the University of Rochester Cancer Center Clinical Community Oncology Program Research Base. Journal of Clinical Oncology, 30, 1974-1979.
    Kirshner, J., Heckler, C., Reichel, T., McAuliffe, C., & Morrow, G. (2011). A phase II study of loratidine (L) to prevent pegfilgrastim-induced pain (PIP). Journal of Clinical Oncology, 29(15, Suppl.), e19704.
    Kirshner, J., Heckler, C., Reichel, T., & Morrow, G. (2010). A phase II study of loratidine (L) and naproxen (N) to prevent pegfilgrastim-induced pain (PIP). Journal of Clinical Oncology, 30(15, Suppl.), e19510.
    Pinto, L., Liu, Z., Doan, Q., Bernal, M., Dubois, R., & Lyman, G. (2007). Comparison of pegfilgrastim with filgrastim on febrile neutropenia, grade IV neutropenia, and bone pain: A meta-analysis of randomized controlled trials. Current Medical Research and Opinion, 23, 2283-2295. doi:10.1185/30079907x219599
    Amgen Inc. (2011). Neulasta® (pegfilgastrim) [Package insert]. Retrieved from http://pi.amgen.com/united_states/neulasta/neulasta_pi_hcp_english.pdf
    Citron, M., Berry, D., Cirrincione, C., Hudis, C., Winer, E., Gradishar, W., … Norton, L. (2003). Randomized trial of dose-dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer: First report of intergroup trial C9741/Cancer and Leukemia Group B Trail 9741. Journal of Clinical Oncology, 21, 1431-1439.
    Gregory, S., Schwartzberg, L., Mo, M., Sierra, J., & Vogel, C. (2010). Evaluation of reported bone pain in cancer patients receiving chemotherapy in pegfilgrastim clinical trials: A retrospective analysis. Community Oncology, 7, 297-308.
    Kirshner, J., Heckler, C., Janelsins, M., Dakhil, S., Hopkins, J., Coles, C., & Morrow, G. (2012). Prevention of pegfilgrastim-induced bone pain: A phase III double-blind placebo-controlled randomized clinical trial to the University of Rochester Cancer Center. Journal of Clinical Oncology, 30, 1974-1979.
    Kirshner, J., Heckler, C., Reichel, T., McAuliffe, C., & Morrow, G. (2011). A phase II study of loratidine (L) to prevent pegfilgrastim-induced pain (PIP). Journal of Clinical Oncology, 29(15, Suppl.), e19704.
    Kirshner, J., Heckler, C., Reichel, T., & Morrow, G. (2010). A phase II study of loratidine (L) and naproxen (N) to prevent pegfilgrastim-induced pain (PIP). Journal of Clinical Oncology, 30(15, Suppl.), e19510.
    Kirshner, J., Hickok, J., & Hofman, M. (2007). Pegfilgrastim-induced bone pain: Incidence, risk factors, and management in a community practice. Community Oncology, 4, 455-459.
    Kubista, E., Glaspy, J., Holmes, F.A., Green, M.D., Hackett, J., & Neumann, T. (2003). Bone pain associated with once-per cycle pegfilgrastim is similar to daily filgrastim in patients with breast cancer. Clinical Breast Cancer, 3, 391-398.
    Kummel, S., Krocker, J., Kohls, A., Breitbach, G.P., Morack, G., Budner, M., … Elling, D. (2006). Randomized trial: Survival benefit and safety of adjuvant dose-dense chemotherapy for node-positive breast cancer. British Journal of Cancer, 94, 1237-1244.
    National Comprehensive Cancer Network. (2013). NCCN Clinical Practice Guidelines in Oncology®. Myeloid growth factors [v.2.2013]. Retrieved from http://bit.ly/N8tXMp
    Pinto, L., Liu, Z., Doan, Q., Bernal, M., Dubois, R., & Lyman, G. (2007). Comparison of pegfilgrastim with filgrastim on febrile neutropenia, grade IV neutropenia, and bone pain: A meta-analysis of randomized controlled trials. Current Medical Research and Opinion, 23, 2283-2295.
    Smith, T.J., Khatcheressian, J., Lyman, G.H., Armitage, J.O., Balducci, L., Bennett, C.C., … Wolf, A.C. (2006). 2006 update of recommendations for the use of white blood cell growth factors. Journal of Clinical Oncology, 24, 3187-3205.
    Walbridge, H. (2012). Claritin and neulasta. Retrieved from http://bit.ly/1gPXXtH
    Wood, S. (2008). Assessment of pain. Retrieved from http://bit.ly/1ayGZgA