All about NHL

Good morning Colin, yes, many will have had exactly the same experiences with Filgrastim (G-CSF Injections)

The G-CSF is used to give the bone-marrow a kick start to get it going it producing the stuff you need and this is a normal experience.

I was on them after each cycle of my main Chemo then for over a month following my two Stem Cell Transplants and did have the same effects.

My team gave my some antihistamines as for some reason this helped the pain.

Edit - I was prescribed Claritin

Hi, Colin. Yes, totally normal and very unpleasant. My first course affected me but with the second course I took it just before bed with paracetamol and much less pain. It just has to be tolerated...its doing it's job, stimulating the bone marrow.

Hope this helps (I'm still not used to sticking a needle in myself and have been on clexane a blood thinner for weeks with daily injections!!)

Regards, Lynda xx

Hello Mike. thank you for your reply, did you get the pains in the back

as I described? When did you take the Claritin, at the same time as your injection

or later?

thanks again. Colin

Hello Lynda. thank you for your reply. the hospital told me the injections

could give me pain but I never realised they would be that bad.

When you don't know what to do with yourself in between Spasms.

Maybe I have a very low pain threshold, or I am just a wimp?

Thanks again Lynda.

Colin x

Hi Colin, the pains were in different places at diffrent times. But a lot up and down the spine with shooting pains. My nurses called them birthing pains and at times they were every few seconds, it was just my Bonemarrow getting a move on.

I took the Claritin an hour before each injection but it does make you rather sleepy so I never drove during these times,

Colin,

Not a wimp at all! The first time you don't know what to with yourself. I thought it was our new mattress screwing with my back so i sold it! But the other times you will know what to expect. It is not comfortable but at least once your blood is back up you can stop it again. I tried to very carefully move and take paracetemol. Which seems to take the edge off. It is doing something good so best to just take a step back and try to relax so you don't have to move too much. 

Dear Colin -Good Morning from Kauai,

Sorry to hear about your severe bone pain after FILGRASTIM.  You are not alone. Bone pain is common with Filgrastim use (59% in general) and severe pain in 29% of patients . Newer studies (case studies and trials) have discovered showing that 10mg of Claritin (loratadine) day before chemo, day of chemo and 5 days after chemo in conjunction with NSAID after can relieve severe bone pain caused by FILGRASTIM,.  Please discuss this option with your team and get their opinion. I have attached four peer reviewed medical publications below for you share with your team.  Discuss with your team about using an antihistamine to prevent severe pain with them before your next chemo.  

All my best,
Millie

1. J Oncol Pharm Pract. 2015 Aug;21(4):301-4. doi: 10.1177/1078155214527858. Epub 2014 Mar 24. Severe pegfilgrastim-induced bone pain completely alleviated with loratadine: A case report. Romeo C(1), Li Q(2), Copeland L(3). Author information: (1)College of Pharmacy, The Ohio State University, Columbus, OH, USA. (2)James Cancer Hospital, The Ohio State University, Columbus, OH, USA Quan.Li@osumc.edu. (3)College of Medicine, The Ohio State University, Columbus, OH, USA.

Febrile neutropenia is an oncologic emergency that can result in serious consequences. Granulocyte colony stimulating factors (G-CSFs) are often used as prophylaxis for febrile neutropenia. Bone pain is the most notorious adverse effect caused by G-CSFs. Specifically, with pegfilgrastim (Neulasta(®)), the incidence of bone pain is higher in practice than was observed during clinical trials. Traditional analgesics, such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, can be ineffective in severe pegfilgrastim-induced bone pain. With the high frequency of this adverse effect, it is clear that health practitioners need additional treatment options for patients who experience severe pegfilgrastim-induced bone pain. The mechanisms of bone pain secondary to G-CSFs are not fully known, but research has shown that histamine release is involved in the inflammatory process. There is scant previous clinical data on antihistamine use in the management of G-CSF-induced pain. We present the first case report in which loratadine prophylaxis completely alleviated NSAID-resistant severe pain secondary to pegfilgrastim. The result showed that loratadine may be a promising option for severe, resistant pegfilgrastim-induced bone pain. Further clinical studies are warranted and ongoing. © The Author(s) 2014. DOI: 10.1177/1078155214527858 PMID: 24664474 [Indexed for MEDLINE]

2. J Emerg Med. 2017 Feb;52(2):e29-e31. doi: 10.1016/j.jemermed.2016.08.018. Epub 2016 Oct 14. When Hydromorphone Is Not Working, Try Loratadine: An Emergency Department Case of Loratadine as Abortive Therapy for Severe Pegfilgrastim-Induced Bone Pain. Moore K(1), Haroz R(2). Author information: (1)Department of Emergency Medicine, Medical Toxicology, Cooper University Hospital, Camden, New Jersey. (2)Department of Emergency Medicine, Medical Toxicology, Cooper University Hospital, Camden, New Jersey; Cooper Medical School of Rowan University, Medical Toxicology, Cooper University Hospital, Camden, New Jersey. BACKGROUND: Intractable bone pain is a notorious adverse effect of granulocyte-colony stimulating factors (G-CSFs), such as pegfilgrastim and filgrastim, which are given to help prevent neutropenia in patients who are undergoing chemotherapy. G-CSF-induced bone pain is surprisingly common and often refractory to treatment with conventional analgesics. CASE REPORT: This article describes an emergency department case of opiate and nonsteroidal anti-inflammatory drug-resistant pegfilgrastim-induced bone pain that was successfully alleviated with 10 mg of oral loratadine, allowing for discharge home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case suggests that loratadine may be an easy to implement, safe, and effective therapy in the emergency department management of intractable bone pain caused by G-CSF use. Emergency physicians should be aware that loratadine may successfully relieve otherwise intractable G-CSF-induced bone pain and allow for discharge home. Copyright © 2016 Elsevier Inc. All rights reserved.

3. J Oncol Pharm Pract. 2016 Jun;22(3):423-9. doi: 10.1177/1078155215585188. Epub 2015 May 7. Pegfilgrastim use and bone pain: a cohort study of community-based cancer patients. Pawloski PA(1), Larsen M(2), Thoresen A(3), Giordana MD(4). Author information: (1)HealthPartners Institute for Education and Research, Minneapolis, MN, USA Regions Hospital Cancer Care Center, St. Paul, MN, USA pamala.a.pawloski@healthpartners.com. (2)University of Minnesota College of Pharmacy, Minneapolis, MN, USA. (3)United Hospital, St. Paul, MN, USA. (4)Regions Hospital Cancer Care Center, St. Paul, MN, USA.

PURPOSE: Bone pain is a common adverse effect of the granulocyte colony-stimulating factors filgrastim and pegfilgrastim. However, the incidence of reported bone pain varies and therapies to mitigate this adverse effect are limited to case reports and one randomized controlled trial. The purpose of this study was to describe pegfilgrastim use, the incidence and treatment of bone pain, and rate of severe or febrile neutropenia among cancer patients receiving pegfilgrastim at a metropolitan, hospital-based, community cancer center. METHODS: This retrospective chart review included the first 100 adult oncology patients who received at least one dose of pegfilgrastim from 1 January 2012 to 31 December 2012. Descriptive analyses were used to evaluate the primary and secondary outcomes. RESULTS: Of the identified cases, 69 cancer patients were evaluable. Most patients (74%) received pegfilgrastim for primary prophylaxis. Pegfilgrastim-associated bone pain occurred in 19% and loratadine was the most common medication used to treat it. Among the patients who received pegfilgrastim for primary prophylaxis, 8% were hospitalized for febrile neutropenia. Among those hospitalized for febrile neutropenia, 64% had not received pegfilgrastim for primary prophylaxis. CONCLUSIONS: Pegfilgrastim is commonly used for primary prophylaxis during the first cycle of chemotherapy. Hospitalizations for febrile neutropenia occurred most commonly among patients without primary prophylaxis. Pegfilgrastim-associated bone pain occurred in a similar percentage, as reported in randomized controlled trials but less than that reported by survey. Loratadine was the most commonly employed medication to mitigate this adverse effect. © The Author(s) 2015. DOI: 10.1177/1078155215585188 PMID: 25956422 [Indexed for MEDLINE]

4. Support Care Cancer. 2018 Apr;26(4):1323-1334. doi: 10.1007/s00520-017-3959-2. Epub 2017 Nov 16. NOLAN: a randomized, phase 2 study to estimate the effect of prophylactic naproxen or loratadine vs no prophylactic treatment on bone pain in patients with early-stage breast cancer receiving chemotherapy and pegfilgrastim. Kirshner JJ(1), McDonald MC 3rd(2), Kruter F(3), Guinigundo AS(4), Vanni L(5), Maxwell CL(6), Reiner M(7), Upchurch TE(7), Garcia J(7)(8), Morrow PK(7). Author information: (1)Hematology-Oncology Associates of Central New York, 5008 Brittonfield Parkway, East Syracuse, NY, 13057, USA. jkirshner@hoacny.com. (2)Willis Knighton Cancer Center, Shreveport, LA, USA. (3)William E Kahlert Regional Cancer Center, Westminster, MD, USA. (4)Oncology Hematology Care Inc., Cincinnati, OH, USA. (5)Ascension Providence, Southfield, MI, USA. (6), TESARO Inc., Waltham, MA, USA. (7)Amgen Inc., Thousand Oaks, CA, USA. (8)Juno Therapeutics Inc., Seattle, WA, USA.

PURPOSE: Mild-to-moderate bone pain is a commonly reported adverse event (AE) associated with pegfilgrastim. We evaluated the effect of prophylactic naproxen or loratadine vs no prophylactic treatment on pegfilgrastim-associated bone pain. METHODS: In this open-label study (NCT01712009), women ≥ 18 years of age with newly diagnosed stage I-III breast cancer and an ECOG performance status ≤ 2 who were planning ≥ 4 cycles of adjuvant or neoadjuvant chemotherapy with pegfilgrastim support starting in cycle 1 were randomized 1:1:1 to receive naproxen, loratadine, or no treatment to prevent pegfilgrastim-associated bone pain. The primary endpoint was all-grade bone pain in cycle 1 from AE reporting. Secondary endpoints included bone pain in cycles 2-4 and across all cycles from AE reporting and patient-reported bone pain by cycle and across all cycles. RESULTS: Six hundred patients were enrolled. Most patients (83.0%) were white, and mean (SD) age was 54.2 (11.1) years. The percentage of patients with all-grade bone pain in cycle 1 from AE reporting in the naproxen, loratadine, and no prophylaxis groups was 40.3, 42.5, and 46.6%, respectively; differences between the treatment groups were not statistically significant. Maximum, mean, and area under the curve for patient-reported bone pain were consistently lower in the naproxen and loratadine groups than in the no prophylaxis group; some of these differences were significant. Loratadine was associated with fewer treatment-related AEs and discontinuations than naproxen. CONCLUSIONS: Given its tolerability, its ease of administration, and its potential benefit, treatment with loratadine should be considered to help prevent bone pain in patients receiving chemotherapy and pegfilgrastim. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov ; NCT01712009. DOI: 10.1007/s00520-017-3959-2 PMCID: PMC5847062 PMID: 29147854 [Indexed for MEDLINE]

Hello Ducthie. Thank you, you made me laugh selling the mattress, If I don't sleep well tonight

I might sell the whole bed. I have taken paracetamol the last couple of days, once they took the edge off

but yesterday they did not touch it. glad to hear your free from cancer. please stay that way.

Colin.

Hello Millie. thank you for all the information you sent through.

had a good read of all the stats.

Just taken a antihistime , one of my pre chemo tabs.

see how I get on this evening.

Take care. Colin.

Hello Mike. thanks again. just taken a antihistamin . one of my pre chemo tablets.

see how I get on this evening.

Colin.