Factors associated with the duration of neutropenia in acute leukemia patients receiving chemotherapy at Prof. Dr. I.G.N.G. Ngoerah Hospital

Predicting Duration of Neutropenia After Successful Intensive Induction Chemotherapy for Acute Myeloid Leukemia or High-Grade Myelodysplastic Syndromes

Pegfilgrastim compared with Filgrastim after autologous hematopoietic peripheral blood stem cell transplantation

Impact of Duration of Neutropenia and Lymphopenia on AML Patients Undergoing Induction Chemotherapy

e19011 Background: Chimeric antigen receptor (CAR) T-cell therapy for B-cell lymphomas is increasing in use and predictive tools, like CAR-HEMATOTOX, help identify patients at risk for prolonged neutropenia (NP). This tool, validated in two cohorts, lacks confounding by race, but applicability to minority populations is unknown. Here we describe hematologic toxicities and evaluate possible predictors of toxicity in patients who received axicabtagene ciloleucel (AC) in a majority minority population. Methods: We conducted a single-center retrospective analysis of adults ≥ 18 years who received AC at Montefiore Einstein Comprehensive Cancer Center in the Bronx, NY. Descriptive statistics were used to define patient characteristics. Univariate linear regression models were used to evaluate possible predictors of hematologic toxicity. Statistical analyses were performed using R programming. Results: Between June 2018 and December 2024, 81 patients received AC; 23 (28%) identified as Hispanic, 19 (23%) non-Hispanic Black, 27 (33%) non-Hispanic White, four (5%) Asian/Pacific Islander, and eight (10%) were self-identified as other race/ethnicity. 35 patients (43.2%) experienced profound NP (absolute neutrophil count [ANC] < 100 cells per µL) and 73 patients (90.1%) experienced severe NP (ANC < 500 cells per µL). The median duration of severe NP was 8 days (range 0 - 49 days). On univariate analysis lower baseline white blood cell count (WBC) and ANC measured 30 - 40 days prior to AC significantly correlated with duration and severity of NP (p < 0.01). WBC and ANC were highly correlated; WBC was a surrogate for ANC. Lower hemoglobin level on the day of infusion (D0) also significantly correlated with duration of NP (p < 0.05), not with severity. Baseline c-reactive protein (n = 64) and ferritin (n = 52) did not correlate with duration or severity of NP. Age at the time of CART infusion, sex (male or female) and race did not correlate with either outcome, but number of previous lines of treatment correlated with both duration (p < 0.01) and severity (p < 0.05). 32 out of 81 patients (39.5%) were classified as low-risk and 49 (60.5%) as high-risk based on the CAR-HEMATOTOX model. Neither CAR-HEMATOTOX score nor risk class correlated with duration or severity of NP. Each factor was a poor predictor of duration or severity of NP based on the models adjusted r 2 value. The best predictor of severity of NP was the WBC on the D0 (r 2 = 0.30), and of duration of NP was the number of lines of previous treatment (r 2 = 0.11). Conclusions: CAR-HEMATOTOX is a tool to stratify patients likely to have cytopenias, and in this majority minority population it did not correlate with severe or prolonged NP after AC. We plan to expand these results to include patients who received other CAR-Ts, and to describe the prevalence of non-hematologic toxicities. Further studies are needed to predict cytopenias after CAR-T, especially as outpatient CAR-T is explored.

Intensive Post-Remission Consolidation with G-CSF-Support: Tolerability, Safety, Reduced Hospitalization, and Efficacy of a New Treatment Protocol for AML Patients ≥60 Years

Microbiological Analysis of Bloodstream Infections in Patients with Acute Leukemia and the Association with Prognosis

The CAR-Hematotox Score Identifies Patients at High Risk for Hematological Toxicity, Infections and Poor Clinical Outcomes Following Brexucabtagene Autoleucel in Relapsed/Refractory Mantle Cell Lymphoma

Risk factors for multidrug-resistant bacteremia in hospitalized cancer patients with febrile neutropenia: A cohort study

G-CSF Starting Day +1 after Autologous Transplant Is Safer Than Day +5 or Day +7 in Patients with Multiple Myeloma

A Comparison of Therapeutic Schedules for Administering Granulocyte Colony-Stimulating Factor to Nonhuman Primates After High-Dose Chemotherapy

An open-label, multicentre, randomised phase 2 study of recombinant human granulocyte colony-stimulating factor (filgrastim) as an adjunct to combination chemotherapy in paediatric patients with metastatic neuroblastoma.

Use of growth factor after high-dose chemotherapy (HDC) and autologous peripheral blood stem cell (PBSC) support is current standard in reducing days of neutropenia. This retrospective study aims to compare the efficacy of two standard growth factors, pegfilgrastim (PEG) and filgrastim (FIL) after HDC. We collected data on 195 consecutive adult patients who received an autotransplant (myeloma, lymphoma and others) between January 2004 and December 2014 at two tertiary care centres. The primary end point was the duration of neutropenia in terms of days to reach an ANC > 0.5 × 109/L. Filgrastim was given to 110 patients and PEG was given to 85 patients. Time to engraftment, defined as the time to reach an ANC of 0.5 × 109/L on 2 consecutive days after the day of auto-SCT, was 12.6days with FIL compared with 12.1days with PEG group (p = 0.126). When comparing the total days of severe neutropenia (WBC < 0.1 × 109/L), there were 5.5days of severe neutropenia with FIL compared with 5.8days with PEG group (p = 0.7). The duration of febrile neutropenia was an average of 5.3days with FIL and 4.6days with PEG (p = 0.029). The total number of antibiotic days was shorter for the patients who received PEG, being 11.08days with PEG and 12.1days with FIL (p = 0.184).The average cost savings per person in terms of number of days of hospitalization and number of days of total parental nutrition was 582 Rs (p = 0.512) and 6003 Rs (p = 0.018) respectively in favour of PEG arm. PEG is similar to FIL in hematological reconstitution, however it is more cost effective alternative after HDC and PBSC.

Background: Assessment of nutritional status of paediatric oncology patients is crucial, as it may influence treatment and clinical outcomes. Concurrent malnutrition and cancer in children may lead to reduced chemotherapy delivery due to impaired tolerance and increased toxicity.Aim: This study aimed to determine the relationship between nutritional status and the prevalence, frequency and duration of treatment-related neutropenia in a cohort of South African children with nephroblastoma.Methods: Seventy-seven children between the ages of 1 and 12 years diagnosed with nephroblastoma at Inkosi Albert Luthuli Central Hospital (IALCH), Durban, between 2004 and 2012, were studied prospectively. Nutritional status was assessed using weight, height, mid-upper arm circumference (MUAC), triceps skinfold thickness (TSFT) and serum albumin. The administration of filgastrim (Neupogen®) was used as a surrogate for neutropenia and the frequency and duration of its use was recorded.Results: There was a significant relationship between the prevalence of treatment-induced neutropenia and malnutrition defined by MUAC. The mean frequency and duration of neutropenia was significantly higher in those classified as malnourished using MUAC. There was a positive correlation between frequency and duration of neutropenia.Conclusions: Malnutrition was prevalent among children with nephroblastoma. The prevalence of treatment-induced neutropenia was higher in those with poor nutritional status, identified by MUAC. Poor nutritional status according to MUAC was also linked to an increased frequency and duration of neutropenia. It is important to include MUAC in the nutritional assessment of children with nephroblastoma.

Impact of G-CSF for Outcomes of Non-M3 AML Patients Who Were Treated By Anthracycline-Based Induction (7+3 regimen) Chemotherapies

Prophylactic colony-stimulating factors in children receiving myelosuppressive chemotherapy: A meta-analysis of randomized controlled trials