Pegfilgrastim-bmez Subcu Soln Syringe 6 MG/0.6ML (Ziextenzo)

Pegfilgrastim-bmez Subcu Soln Syringe 6 MG/0.6ML (Ziextenzo)

Non-Formulary Use Criteria: **1. Adjunctive therapy for cancer chemotherapy. a. Chemotherapy primary prophylaxis for “dose dense” treatment regimen. b. Chemotherapy primary prophylaxis for treatment regimen with 20% or higher risk of febrile neutropenia. Table of Contents 45 c. Chemotherapy primary prophylaxis for patient older than 65, poor performance status, combined chemo-radiotherapy, poor nutritional status, advanced cancer, or other serious comorbidities. d. Chemotherapy secondary prophylaxis for patient with history of prior neutropenic complications.** **2. All of the following must be true for patient to be eligible for filgrastim treatment of hepatitis C treatment-related neutropenia: a. Patient receiving hepatitis C therapy; AND b. Patient develops neutropenia defined as either i. ANC < 250/mm3; OR ii. ANC < 500mm3 with one of the following risk factors for developing infection; a. Cirrhosis, biopsy proven or clinically evident; b. Pre-or post-liver transplant; c. HIV/HCV co-infection d. Receiving HCV triple therapy; AND c. Patient has failed to respond (i.e. neutropenia persists) despite at least two weeks of peginterferon dose reduction** Formulary Restrictions: **"Oncologist/Hematologist Use only"** **Medical Referral Center (MRC) Use Only** **MLP Requires Cosign**

Dr. M Blatstein

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