Pegfilgrastim-Induced Pain in Patients With Lymphoma
Pegfilgrastim-Induced Pain in Patients With Lymphoma
Pegfilgrastim acts on hematopoietic cells by binding to specific cell surface receptors, thereby stimulating proliferation, differentiation, commitment, and end-cell functional activation. Pegfilgrastim has a half life of 15–80 hours after subcutaneous injection (Amgen Inc., 2011).
An unwanted side effect of pegfilgrastim and filgrastim treatment is bone pain. The exact mechanism of filgrastim or pegfilgrastim-induced pain (PIP) is unknown, but Walbridge (2012) speculated that bone pain is caused by histamine-related inflammation. Bone pain has been reported in 26%–37% of patients in early clinical trials; however, in clinical practice, the incidence of pain seems to be significantly higher (Kirshner et al., 2012). Kirshner et al. (2012) reported (N = 510) an overall incidence of 59% of patients reporting pain, with 24% of patients experiencing severe bone pain. According to the results of early clinical trials, no risk factors have been identified to predict patients who might experience pain after pegfilgrastim or filgrastim administration (Kirshner et al., 2012; Kirshner, Hickok, & Hofman, 2007; Pinto et al., 2007).
Findings from a retrospective analysis conducted by Gregory et al. (2010) from clinical trials suggested that any grade bone pain may be more common in younger patients (younger than age 65 years) than in older patients (age 65 years and older) who are receiving chemotherapy. In non-small cell lung cancer, grade 3/4 bone pain was high and may be caused by the use of carboplatin and paclitaxel. In addition, bone pain of any grade appeared more common in patients who received taxanes than those who did not receive taxanes. Unfortunately, PIP is unpredictable and refractory to many analgesics, particularly opioids (Kirshner et al., 2007).
Pegfilgrastim-Induced Pain
Pegfilgrastim acts on hematopoietic cells by binding to specific cell surface receptors, thereby stimulating proliferation, differentiation, commitment, and end-cell functional activation. Pegfilgrastim has a half life of 15–80 hours after subcutaneous injection (Amgen Inc., 2011).
An unwanted side effect of pegfilgrastim and filgrastim treatment is bone pain. The exact mechanism of filgrastim or pegfilgrastim-induced pain (PIP) is unknown, but Walbridge (2012) speculated that bone pain is caused by histamine-related inflammation. Bone pain has been reported in 26%–37% of patients in early clinical trials; however, in clinical practice, the incidence of pain seems to be significantly higher (Kirshner et al., 2012). Kirshner et al. (2012) reported (N = 510) an overall incidence of 59% of patients reporting pain, with 24% of patients experiencing severe bone pain. According to the results of early clinical trials, no risk factors have been identified to predict patients who might experience pain after pegfilgrastim or filgrastim administration (Kirshner et al., 2012; Kirshner, Hickok, & Hofman, 2007; Pinto et al., 2007).
Findings from a retrospective analysis conducted by Gregory et al. (2010) from clinical trials suggested that any grade bone pain may be more common in younger patients (younger than age 65 years) than in older patients (age 65 years and older) who are receiving chemotherapy. In non-small cell lung cancer, grade 3/4 bone pain was high and may be caused by the use of carboplatin and paclitaxel. In addition, bone pain of any grade appeared more common in patients who received taxanes than those who did not receive taxanes. Unfortunately, PIP is unpredictable and refractory to many analgesics, particularly opioids (Kirshner et al., 2007).
Source...