Use of PEG-filgrastim or filgrastim after high dose conditioning with BEAC chemotherapy in patients with lymphoma

Abstract

Colony stimulating factors are routinely used after high dose chemotherapy and autologous transplant. Few data are available addressing the efficacy of PEG-filgrastim. Thirty-one consecutive patients who underwent BEAC conditioning and autologous transplant for lymphoma at a single institution were analyzed. One patient died prior to neutrophil recovery and is not included in this analysis. Nineteen patients received filgrastim either 480 mcg if they weighed >60 kg or 300 mcg for a weight <60 kg subcutaneously daily starting day +5 and continuing until ANC > 500. Eleven patients received 6 mg PEG-filgrastim on day +1. The median number of CD34+ cells/kg was 3.9 (1.7–8.2) in the filgrastim group and 2.9 (1.7–9.1) in the PEG-filgrastim group. The median number of prior cytotoxic chemotherapeutic regimens was 1 (1–3) in the filgrastim group and 1 (1–2) in the PEG-filgrastim group. Diagnoses in the filgrastim group: diffuse large B-cell lymphoma (6), follicular lymphoma (7), or mantle cell lymphoma (6). Diagnoses in the PEG-filgrastim group: diffuse large B-cell lymphoma (2), follicular lymphoma (3), mantle cell lymphoma (3), anaplastic T cell lymphoma (1), or cutaneous T cell lymphoma (2). For the filgrastim group, the median time to neutrophil engraftment was 10 days (9–13); the median time to platelet engraftment was 10 days (8–15). For the PEG-filgrastim group the median time to neutrophil engraftment in was 11 days (8–16); the median time to platelet engraftment was 14 days (10–16). The median number of injections in the filgrastim group was 5 (4–7). Conclusions: Both filgrastim and PEG-filgrastim allow for prompt neutrophil recovery in patients undergoing BEAC conditioning and autologous transplant. Factors other than efficacy such as convenience, patient comfort and cost should be considered when choosing a post transplant colony stimulating factor. Colony stimulating factors are routinely used after high dose chemotherapy and autologous transplant. Few data are available addressing the efficacy of PEG-filgrastim. Thirty-one consecutive patients who underwent BEAC conditioning and autologous transplant for lymphoma at a single institution were analyzed. One patient died prior to neutrophil recovery and is not included in this analysis. Nineteen patients received filgrastim either 480 mcg if they weighed >60 kg or 300 mcg for a weight <60 kg subcutaneously daily starting day +5 and continuing until ANC > 500. Eleven patients received 6 mg PEG-filgrastim on day +1. The median number of CD34+ cells/kg was 3.9 (1.7–8.2) in the filgrastim group and 2.9 (1.7–9.1) in the PEG-filgrastim group. The median number of prior cytotoxic chemotherapeutic regimens was 1 (1–3) in the filgrastim group and 1 (1–2) in the PEG-filgrastim group. Diagnoses in the filgrastim group: diffuse large B-cell lymphoma (6), follicular lymphoma (7), or mantle cell lymphoma (6). Diagnoses in the PEG-filgrastim group: diffuse large B-cell lymphoma (2), follicular lymphoma (3), mantle cell lymphoma (3), anaplastic T cell lymphoma (1), or cutaneous T cell lymphoma (2). For the filgrastim group, the median time to neutrophil engraftment was 10 days (9–13); the median time to platelet engraftment was 10 days (8–15). For the PEG-filgrastim group the median time to neutrophil engraftment in was 11 days (8–16); the median time to platelet engraftment was 14 days (10–16). The median number of injections in the filgrastim group was 5 (4–7). Conclusions: Both filgrastim and PEG-filgrastim allow for prompt neutrophil recovery in patients undergoing BEAC conditioning and autologous transplant. Factors other than efficacy such as convenience, patient comfort and cost should be considered when choosing a post transplant colony stimulating factor.