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Pegfilgrastim: More Cost Effective and Equally Efficacious Option as Compared to Filgrastim in Autologous Stem Cell Transplant

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Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

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 12.6 days with FIL compared with 12.1 days with PEG group (p = 0.126). When comparing the total days of severe neutropenia (WBC < 0.1 × 109/L), there were 5.5 days of severe neutropenia with FIL compared with 5.8 days with PEG group (p = 0.7). The duration of febrile neutropenia was an average of 5.3 days with FIL and 4.6 days with PEG (p = 0.029). The total number of antibiotic days was shorter for the patients who received PEG, being 11.08 days with PEG and 12.1 days 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.

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References

  1. Schmitz N, Linch DC, Dreger P et al (1996) Randomized trial of filgrastim-mobilised peripheral blood progenitor cell transplantation versus autologous bone-marrow transplantation in lymphoma patients. Lancet 347:353–357

    Article  CAS  PubMed  Google Scholar 

  2. Hartmann O, Le Corroller AG, Blaise D et al (1997) Peripheral blood stem cell and bone marrow transplantation for solid tumors and lymphomas: hematologic recovery and costs. A randomized, controlled trial. Ann Intern Med 126:600–607

    Article  CAS  PubMed  Google Scholar 

  3. Tarella C, Castellino C, Locatelli F et al (1998) G-CSF administration following peripheral blood progenitor cell (PBPC) autograft in lymphoid malignancies: evidence for clinical benefits and reduction of treatment costs. Bone Marrow Transplant 21:401–407

    Article  CAS  PubMed  Google Scholar 

  4. Linch DC, Milligan DW, Winfield DA et al (1997) G-CSF after peripheral blood stem cell transplantation in lymphoma patients significantly accelerated neutrophil recovery and shortened time in hospital: results of a randomized BNLI trial. Br J Haematol 99:933–938

    Article  CAS  PubMed  Google Scholar 

  5. Klumpp TR, Mangan KF, Golderg SL et al (1995) Granulocyte colony-stimulating factor accelerates neutrophil engraftment following peripheral-blood stem-cell transplantation: a prospective, randomized trial. J Clin Oncol 13:1323–1327

    Article  CAS  PubMed  Google Scholar 

  6. Lee SM, Radford JA, Dobson L et al (1998) Recombinant human granulocyte colony stimulating factor (filgrastim) following high-dose chemotherapy and peripheral blood progenitor cell rescue in high-grade non-Hodgkin’s lymphoma: clinical benefits at no extra cost. Br J Cancer 77:1294–1299

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Spitzer G, Adkins DR, Spencer V et al (1994) Randomized study of growth factors postperipheral-blood stem-cell transplant: neutrophil recovery is improved with modest clinical benefit. J Clin Oncol 12:661–670

    Article  CAS  PubMed  Google Scholar 

  8. Dunlop DJ, Fitzsimons EJ, McMurray A et al (1994) Filgrastim fails to improve haematopoietic reconstitution following myeloablative chemotherapy and peripheral blood stem cell rescue. Br J Cancer 70:943–945

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Kawano Y, Takaue Y, Mimaya J et al (1998) Marginal benefit/disadvantage of granulocyte colony-stimulating factor therapy after autologous blood stem cell transplantation in children: results of a prospective randomized trial. The Japanese Cooperative Study Group of PBSCT. Blood 92:4040–4046

    CAS  PubMed  Google Scholar 

  10. Smith TJ, Khatcheressian J, Lyman GH et al (2006) 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol 24:3187–3205

    Article  CAS  PubMed  Google Scholar 

  11. Molineux G et al (2003) Pegfilgrastim: using pegylation technology to improve neutropenia support in cancer patients. Anticancer Drugs 14:259–264

    Article  CAS  PubMed  Google Scholar 

  12. Yowell SL, Blackwell S et al (2002) Novel effects with polyethylene glycol modified pharmaceuticals. Cancer Treatm Rev 28(Suppl A):3–6

    Article  CAS  Google Scholar 

  13. Molineux G, Kinstler O, Briddell B et al (1999) A new form of Filgrastim with sustained duration in vivo and enhanced ability to mobilize PBPC in both mice and humans. Exp Hematol 27:1724–1734

    Article  CAS  PubMed  Google Scholar 

  14. Johnston E, Crawford J, Blackwell S et al (2000) Randomized, dose-escalation study of SD/01 compared with daily filgrastim in patients receiving chemotherapy. J Clin Oncol 18:2522–2528

    Article  CAS  PubMed  Google Scholar 

  15. Holmes FA, Jones SE, O’Shaughnessy J et al (2002) Comparable efficacy and safety profiles of once-per-cycle pegfilgrastim and daily injection filgrastim in chemotherapy-induced neutropenia: a multicenter dose-finding study in women with breast cancer. Ann Oncol 13:903–909

    Article  CAS  PubMed  Google Scholar 

  16. Vose JM, Crump M, Lazarus H et al (2003) Randomized, multicenter, open-label study of pegfilgrastim compared with daily filgrastim after chemotherapy for lymphoma. J Clin Oncol 21:514–519

    Article  CAS  PubMed  Google Scholar 

  17. Holmes FA, O’Shaughnessy JA, Vukelja S et al (2002) Blinded, randomized, multicenter study to evaluate single administration pegfilgrastim once per cycle versus daily filgrastim as an adjunct to chemotherapy in patients with high-risk stage II or stage III/IV breast cancer. J Clin Oncol 20:727–731

    Article  CAS  PubMed  Google Scholar 

  18. Green MD, Koelbl H, Baselga J et al (2003) A randomized double-blind multicenter phase III study of fixed-dose single-administration pegfilgrastim versus daily filgrastim in patients receiving myelosuppressive chemotherapy. Ann Oncol 14:29–35

    Article  CAS  PubMed  Google Scholar 

  19. Castagna L, Bramanti S, Levis A et al (2009) Pegfilgrastim versus filgrastim after high-dose chemotherapy and autologous peripheral blood stem cell support. Ann Oncol 21:1482–1485

    Article  PubMed  Google Scholar 

  20. Gerds A, Fox-Geiman M et al (2010) Randomized phase III trial of pegfilgrastim versus filgrastim after autologus peripheral blood stem cell transplantation. Biol Blood Marrow Transplant 16:678–685

    Article  CAS  PubMed  Google Scholar 

  21. Bruns I, Steidl U, Fischer JC et al (2008) Pegylated granulocyte colony-stimulating factor mobilizes CD34 cells with different stem and progenitor subsets and distinct functional properties in comparison with unconjugated granulocyte colony-stimulating factor. Haematologica 93:347–355

    Article  CAS  PubMed  Google Scholar 

  22. Jagasia MH, Greer JP, Morgan DS et al (2005) Pegfilgrastim after high-dose chemotherapy and autologous peripheral blood stem cell transplant: phase II study. Bone Marrow Transplant 35:1165–1169

    Article  CAS  PubMed  Google Scholar 

  23. Vanstraelen G, Frere P, Ngirabacu MC et al (2006) Pegfilgrastim compared with Filgrastim after autologous hematopoietic peripheral blood stem cell transplantation. Exp Hematol 34:382–388

    Article  CAS  PubMed  Google Scholar 

  24. Todisco E, Castagna L, Sarina B et al (2007) CD34+ dose-driven administration of granulocyte colony-stimulating factor after high-dose chemotherapy in lymphoma patients. Eur J Haematol 78:111–116

    Article  CAS  PubMed  Google Scholar 

  25. Staber PB, Holub R, Linkesch W et al (2005) Fixed-dose single administration of Pegfilgrastim vs daily Filgrastim in patients with haematological malignancies undergoing autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 35:889–893

    Article  CAS  PubMed  Google Scholar 

  26. Porrata LF, Gertz MA, Inwards DJ et al (2001) Early lymphocyte recovery predicts superior survival after autologous hematopoietic stem cell transplantation in multiple myeloma or non-Hodgkin lymphoma. Blood 98:579–585

    Article  CAS  PubMed  Google Scholar 

  27. Mathew S, Adel N, Rice RD et al (2010) Retrospective comparison of the effects of filgrastim and pegfilgrastim on the pace of engraftment in auto-SCT patients. Bone Marrow Transplant 45:1522–1527

    Article  CAS  PubMed  Google Scholar 

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Acknowledgement

Prof Navin Khattry and Prof Arnon Nagler for valuable inputs during preparation of manuscript.

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Author notes

  1. V. Sheth, A. Gore, R. Jain and A. Ghanekar have contributed equally to the article. V. Sheth and T. Saikia are corresponding authors to the manuscript.

Authors and Affiliations

  1. Bone Marrow Transplantation and Medical Oncology Department, Prince Aly Khan Hospital, Mumbai, India

    V. Sheth, A. Gore, R. Jain, A. Ghanekar & T. Saikia

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  1. V. Sheth
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  2. A. Gore
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  3. R. Jain
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  4. A. Ghanekar
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  5. T. Saikia
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Contributions

VS, RJ and AG contributed equally, wrote manuscript, analyzed data, designed study, treated patients; AG, treated patients; TS, mentored manuscript, treated patients, designed study.

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Correspondence to V. Sheth or T. Saikia.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.Acknowledgement, Prof Navin Khattry and Prof Arnon Nagler for valuable inputs during preparation of manuscript.

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Sheth, V., Gore, A., Jain, R. et al. Pegfilgrastim: More Cost Effective and Equally Efficacious Option as Compared to Filgrastim in Autologous Stem Cell Transplant. Indian J Hematol Blood Transfus 35, 66–71 (2019). https://doi.org/10.1007/s12288-018-0966-5

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  • DOI: https://doi.org/10.1007/s12288-018-0966-5

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