1
|
Zhu X, Zhang W, Zhang Y, Wang Y, Hu H, Li J, Zhou Y, Han T, Huang D. Pegfilgrastim on febrile neutropenia in pediatric and adolescent cancer patients: a systematic review and meta-analysis. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2023; 28:2172292. [PMID: 36719297 DOI: 10.1080/16078454.2023.2172292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES There is no meta-analysis about the effects of pegfilgrastim on the occurrence of febrile neutropenia (FN) in pediatric/adolescent cancer patients. The study explored the efficacy of prophylactic pegfilgrastim in preventing FN in children/adolescents with cancer. METHODS PubMed, Embase, and the Cochrane Library were searched for studies published before April 7, 2020. The primary outcome was the rate of FN. Effect size (ES) and odds ratio (OR) with 95% confidence intervals (CIs) were used to evaluate the outcome. The ES represented the rate of FN, and the STATA 'metaprop' command was used to synthesize the rate. RESULTS Eight studies were included, comprising 167 patients and 550 courses of treatment. There was no difference between pegfilgrastim and filgrastim for the rate of FN in children receiving chemotherapy (OR = 0.68, 95% CI: 0.20-2.23, P = 0.520). In patients receiving pegfilgrastim, the rate of FN was 25.6% (95% CI: 14.9%-36.3%), the rate of grade 4 FN was 38.3% (95% CI: 19.2%-59.5%), the rate of severe neutropenia (SN) was 40.5% (95% CI: 35.1%-46.1%), and the rate of treatment delays due to FN was 4.8% (95% CI: 0.8%-11.3%). DISCUSSION The number of studies that could be included was small; therefore, a specific type of cancer or a specific treatment could be studied. Heterogeneity was high. CONCLUSION There was no difference between pegfilgrastim and filgrastim for the rate of FN. The use of pegfilgrastim was still associated with rates of FN, grade 4 FN, severe neutropenia, and treatment delays due to FN in pediatric cancer patients.
Collapse
Affiliation(s)
- Xia Zhu
- Department of Pediatrics, Beijing Tongren Hospital Capital Medical University, Beijing, People's Republic of China
| | - Weiling Zhang
- Department of Pediatrics, Beijing Tongren Hospital Capital Medical University, Beijing, People's Republic of China
| | - Yi Zhang
- Department of Pediatrics, Beijing Tongren Hospital Capital Medical University, Beijing, People's Republic of China
| | - Yizhuo Wang
- Department of Pediatrics, Beijing Tongren Hospital Capital Medical University, Beijing, People's Republic of China
| | - Huimin Hu
- Department of Pediatrics, Beijing Tongren Hospital Capital Medical University, Beijing, People's Republic of China
| | - Jing Li
- Department of Pediatrics, Beijing Tongren Hospital Capital Medical University, Beijing, People's Republic of China
| | - Yan Zhou
- Department of Pediatrics, Beijing Tongren Hospital Capital Medical University, Beijing, People's Republic of China
| | - Tao Han
- Department of Pediatrics, Beijing Tongren Hospital Capital Medical University, Beijing, People's Republic of China
| | - Dongsheng Huang
- Department of Pediatrics, Beijing Tongren Hospital Capital Medical University, Beijing, People's Republic of China
| |
Collapse
|
2
|
Jabagi MJ, Vey N, Goncalves A, Le Tri T, Zureik M, Dray-Spira R. Risk of secondary hematologic malignancies associated with breast cancer chemotherapy and G-CSF support: A nationwide population-based cohort. Int J Cancer 2020; 148:375-384. [PMID: 32683691 DOI: 10.1002/ijc.33216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 12/19/2022]
Abstract
Our study aimed to analyze the risk of hematologic malignancies (HM) associated with the use of G-CSF with chemotherapy for BC. Using the French National Health Data System, we examined the HM risks in patients diagnosed with an incident breast cancer between 2007 and 2015, who received chemotherapy for BC. Main outcomes were acute myeloid leukemia (AML), Myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPNs), multiple myeloma (MM), Hodgkin lymphoma or non-Hodgkin lymphoma (HL/NHL) and acute lymphoblastic leukemia or lymphocytic lymphoma (ALL/LL). Among a total of 122 373 BC survivors, 38.9% received chemotherapy only and 61.1% received chemotherapy + G-CSF. Overall, 781 cases of hematologic malignancies occurred. We observed a nonsignificant increase in the risk of AML (aHR, 1.3; 95% CI, 1.0-1.7), of MDS (aHR, 1.3; 95% CI, 0.9-1.8) and of ALL/LL (aHR, 2.0; 95% CI, 1.0-4.4) among patients treated by chemotherapy + G-CSF compared to chemotherapy only. In analyses by dose, we observed a slight increase in the risk of AML (1-3 doses: aHR, 1.2; 95% CI, 0.8-1.7/4+ doses: aHR, 1.3; 95% CI, 1.0-1.8) and of MDS (1-3 doses: aHR, 1.1; 95% CI, 0.7-1.7/4+ doses: aHR, 1.4; 95% CI, 1.0-1.9), a significant increase in risk of ALL (1-3 doses: aHR, 1.5; 95% CI, 0.5-3.9 / 4+ doses: aHR, 2.3; 95% CI, 1.0-5.1) with increasing cycles of G-CSF. Our population-based study showed that the ALL/LL was the only HM at increased risk with the use of growth factors with a possible dose-effect relationship. Our data regarding the risk of all the other HM are reassuring.
Collapse
Affiliation(s)
- Marie Joelle Jabagi
- EPI-PHARE (French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM)), Saint-Denis, France
| | - Norbert Vey
- Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Aix-Marseille University, Marseille, France
| | - Anthony Goncalves
- Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Aix-Marseille University, Marseille, France
| | - Thien Le Tri
- EPI-PHARE (French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM)), Saint-Denis, France
| | - Mahmoud Zureik
- EPI-PHARE (French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM)), Saint-Denis, France
| | - Rosemary Dray-Spira
- EPI-PHARE (French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM)), Saint-Denis, France
| |
Collapse
|
3
|
Liu KQ, Wang Y, Zhao Z, Lin D, Zhou CL, Liu BC, Gong XY, Zhao XL, Wei SN, Zhang GJ, Gong BF, Li Y, Liu YT, Mi YC, Wang JX, Wei H. [A single-center, randomized controlled trial of PEG-rhG-CSF and common rhG-CSF to promote neutrophil recovery after induction chemotherapy in newly diagnosed acute myeloid leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:497-501. [PMID: 31340623 PMCID: PMC7342402 DOI: 10.3760/cma.j.issn.0253-2727.2019.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Indexed: 11/06/2022]
Abstract
Objective: To compare the time of the recovery of neutrophils or leukocytes by pegylated recombinant human granulocyte stimulating factor (PEG-rhG-CSF) or common recombinant human granulocyte stimulating factor (rhG-CSF) in the myelosuppressive phase after induction chemotherapy in newly diagnosed acute myeloid leukemia (AML) patients. At the same time, the incidences of infection and hospitalization were compared. Methods: A prospective randomized controlled trial was conducted in patients with newly diagnosed AML who met the enrollment criteria from August 2014 to December 2017. The patients were randomly divided into two groups according to a 1:1 ratio: PEG-rhG-CSF group and rhG-CSF group. The time of neutrophil or leukocyte recovery, infection rate and hospitalization interval were compared between the two groups. Results: 60 patients with newly diagnosed AML were enrolled: 30 patients in the PEG-rhG-CSF group and 30 patients in the rhG-CSF group. There were no significant differences in age, chemotherapy regimen, pre-chemotherapy ANC, WBC, and induction efficacy between the two groups (P>0.05) . The median time (range) of ANC or WBC recovery in patients with PEG-rhG-CSF and rhG-CSF were 19 (14-35) d and 19 (15-26) d, respectively, with no statistical difference (P=0.566) . The incidences of infection in the PEG-rhG-CSF group and the rhG-CSF group were 90.0%and 93.3%, respectively, and there was no statistical difference (P=1.000) . The median days of hospitalization (range) was 20.5 (17-49) days and 21 (19-43) days, respectively, with no statistical difference (P=0.530) . Conclusions: In AML patients after induction therapy, there was no significant difference between the application of PEG-rhG-CSF and daily rhG-CSF in ANC or WBC recovery time, infection incidence and hospitalization time.
Collapse
Affiliation(s)
- K Q Liu
- Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Huang HQ, Bai B, Gao YH, Zou DH, Zou SH, Tan H, Song YP, Li ZY, Jin J, Li W, Su H, Gong YP, Zhong MZ, Shuang YR, Zhu J, Zhang JQ, Cai Z, Teng QL, Sun WJ, Yang Y, Xia ZJ, Chen HL, Hua LM, Bao YY, Wu N. [Application of pegylated recombinant human granulocyte colony-stimulating factor to prevent chemotherapy-induced neutropenia in patients with lymphoma: a prospective, multicenter, open-label clinical trial]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 38:825-830. [PMID: 29166732 PMCID: PMC7364967 DOI: 10.3760/cma.j.issn.0253-2727.2017.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
目的 评价聚乙二醇化重组人粒细胞刺激因子(PEG-rhG-CSF)预防淋巴瘤患者化疗后发生中性粒细胞减少症的有效性和安全性。 方法 本研究为多中心、开放、单臂、Ⅳ期临床试验。纳入410例淋巴瘤患者接受多周期化疗并预防性使用PEG-rhG-CSF。主要观察患者各化疗周期Ⅲ/Ⅳ度中性粒细胞减少症和发热性中性粒细胞减少(FN)的发生率,同时观察患者整个化疗期间抗生素的使用率。 结果 ①410例患者中,违背入选标准8例(1.95%),失访35例(8.54%),发生不良事件19例(4.63%),出现符合终止研究标准者12例(2.93%),疾病进展或复发15例(3.66%),故最终321例(78.29%)进入符合方案集。②在第1~4个治疗周期,初级预防给予PEG-rhG-CSF后,Ⅳ度中性粒细胞减少症的发生率分别为19.14%(49/256)、12.50%(32/256)、12.18%(24/197)、13.61%(20/147),FN的发生率分别为3.52%(9/256)、0.39%(1/256)、2.54%(5/197)、2.04%(3/147);次级预防给药后,Ⅳ度中性粒细胞减少症的发生率从61.54%(40/65)降至16.92%(11/65)、18.46%(12/65)、20.75%(11/53),FN的发生率从16.92%(11/65)降至1.54%(1/65)、4.62%(3/65)、3.77%(2/53)。③整个化疗期间接受抗生素治疗的受试者比例为34.39%(141/410)。④与PEG-rhG-CSF相关的不良事件发生率为4.63%(19/410),最常见的不良反应为骨痛[3.90%(16/410)]、乏力(0.49%)和发热(0.24%)。 结论 在淋巴瘤患者化疗过程中,预防性使用PEG-rhG-CSF能够有效降低化疗过程中Ⅲ/Ⅳ度中性粒细胞减少症和FN的发生率,确保淋巴瘤患者接受标准剂量化疗,提高治愈率。
Collapse
Affiliation(s)
- H Q Huang
- Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Vacirca JL, Chan A, Mezei K, Adoo CS, Pápai Z, McGregor K, Okera M, Horváth Z, Landherr L, Hanslik J, Hager SJ, Ibrahim EN, Rostom M, Bhat G, Choi MR, Reddy G, Tedesco KL, Agajanian R, Láng I, Schwartzberg LS. An open-label, dose-ranging study of Rolontis, a novel long-acting myeloid growth factor, in breast cancer. Cancer Med 2018; 7:1660-1669. [PMID: 29573207 PMCID: PMC5943466 DOI: 10.1002/cam4.1388] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/19/2017] [Accepted: 01/18/2018] [Indexed: 12/03/2022] Open
Abstract
This randomized, open‐label, active‐controlled study investigated the safety and efficacy of three doses of Rolontis (eflapegrastim), a novel, long‐acting myeloid growth factor, versus pegfilgrastim in breast cancer patients being treated with docetaxel and cyclophosphamide (TC). The primary efficacy endpoint was duration of severe neutropenia (DSN) during the first cycle of treatment. Patients who were candidates for adjuvant/neoadjuvant TC chemotherapy were eligible for participation. TC was administered on Day 1, followed by 45, 135, or 270 μg/kg Rolontis or 6 mg pegfilgrastim on Day 2. Complete blood counts were monitored daily when the absolute neutrophil count (ANC) fell to <1.5 × 109/L. Up to four cycles of TC were investigated. The difference in DSN (time from ANC <0.5 × 109/L to ANC recovery ≥2.0 × 109/L) between the Rolontis and pegfilgrastim groups was −0.28 days (confidence interval [CI]: −0.56, −0.06) at 270 μg/kg, 0.14 days (CI: −0.28, 0.64) at 135 μg/kg, and 0.72 days (CI: 0.19, 1.27) at 45 μg/kg. Noninferiority to pegfilgrastim was demonstrated at 135 μg/kg (P = 0.002) and 270 μg/kg (P < .001), with superiority demonstrated at 270 μg/kg (0.03 days; P = 0.023). The most common treatment‐related adverse events (AEs) were bone pain, myalgia, arthralgia, back pain, and elevated white blood cell counts, with similar incidences across groups. All doses of Rolontis were well tolerated, and no new or significant treatment‐related toxicities were observed. In Cycle 1, Rolontis demonstrated noninferiority at the 135 μg/kg dose and statistical superiority in DSN at the 270 μg/kg dose when compared to pegfilgrastim.
Collapse
Affiliation(s)
| | - Arlene Chan
- Breast Cancer Research Centre WA and Curtin UniversityPerthWestern AustraliaAustralia
| | - Klára Mezei
- Szabolcs‐Szatmár Bereg County Hospital and University Teaching HospitalNyíregyházaHungary
| | | | | | | | - Meena Okera
- Adelaide Cancer CentreKurralta ParkSouth AustraliaAustralia
| | | | | | - Jerzy Hanslik
- Szpital Rejonowy Dzienny Oddzial ChemioterapiiRaciborzuPoland
| | - Steven J. Hager
- California Cancer Associates for Research and ExcellenceFresnoCalifornia
| | | | | | | | | | - Guru Reddy
- Spectrum PharmaceuticalsIrvineCalifornia
| | - Karen L. Tedesco
- New York Oncology Hematology (US Oncology/McKesson Specialty Health)AlbanyNew York
| | - Richy Agajanian
- The Oncology Institute of Hope and InnovationDowneyCalifornia
| | - István Láng
- National Institute of OncologyBudapestHungary
| | | |
Collapse
|
6
|
Refining the role of pegfilgrastim (a long-acting G-CSF) for prevention of chemotherapy-induced febrile neutropenia: consensus guidance recommendations. Support Care Cancer 2017; 25:3295-3304. [PMID: 28842778 PMCID: PMC5610660 DOI: 10.1007/s00520-017-3842-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/24/2017] [Indexed: 01/09/2023]
Abstract
Purpose Chemotherapy-induced febrile neutropenia (FN) causes treatment delays and interruptions and can have fatal consequences. Current guidelines provide recommendations on granulocyte colony-stimulating factors (G-CSF) for prevention of FN, but guidance is unclear regarding use of short- vs long-acting G-CSF (e.g., filgrastim vs pegfilgrastim/lipegfilgrastim, respectively). An international panel of experts convened to develop guidance on appropriate use of pegfilgrastim for prevention of chemotherapy-induced FN. Methods Guidance recommendations were developed following a literature review, survey, evaluation of current practice, and an expert meeting. Consensus was established using an anonymous Delphi-based approach. Results Guidance recommendations for prevention of treatment-associated FN were as follows: for treatment with curative intent, maintenance of dose intensity using G-CSF to prevent dose delays/reduction should be standard of care; for treatment-associated FN risk ≥ 20%, short-acting G-CSF/pegfilgrastim should be given from cycle 1 onwards; and for treatment-associated FN risk < 20%, short-acting G-CSF/pegfilgrastim should be given if factors suggest overall risk (including treatment-related and patient-related risk factors) is ≥ 20%. It was agreed that pegfilgrastim and 11 days’ filgrastim have similar efficacy and safety and that pegfilgrastim is preferred to < 11 days’ filgrastim (and may be preferred to ≥ 11 days’ filgrastim based on adherence and convenience); pegfilgrastim is not appropriate in weekly chemotherapy; in split-dose chemotherapy, pegfilgrastim is recommended 24 h after last chemotherapy dose; and during palliative chemotherapy, patient adherence and convenience may favor pegfilgrastim. Conclusion In this era of targeted therapies, additional trials with G-CSF are still required. These recommendations should be used with existing guidelines to optimize pegfilgrastim use in clinical practice.
Collapse
|
7
|
Kuan JW, Su AT, Leong CF. Pegylated granulocyte-colony stimulating factor versus non-pegylated granulocyte-colony stimulating factor for peripheral blood stem cell mobilization: A systematic review and meta-analysis. J Clin Apher 2017; 32:517-542. [PMID: 28485020 DOI: 10.1002/jca.21550] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 01/11/2017] [Accepted: 04/04/2017] [Indexed: 12/15/2022]
Abstract
Granulocyte-colony stimulating factor (G-CSF) mobilizes and increases the amount of hematopoietic stem cells in peripheral blood, enabling its harvest by few apheresis procedures. The pegylated G-CSF has longer half-life and is given once only, which is more comfortable for patients, whereas the non-pegylated requires multiple daily injection because of its short half-life. We summarized results of randomized trials comparing the efficacy and safety of pegylated and non-pegylated G-CSF for peripheral blood stem cell mobilization. We searched the Cochrane CENTRAL, MEDLINE, EMBASE, and two conference proceedings. Two authors made the selection, extracted data and evaluated methodological quality using GRADE independently. We used random-effects model for meta-analysis. We found 3956 records and retrieved 47 full texts. We included eight randomized trials with a total number of 554 randomized and 532 analyzed subjects. The meta-analysis included five trials because not all trials reported the same outcomes. Pooling data from two studies shows no evidence for a difference in the successful mobilization rate (CD34+ cell ≥ 2 × 106 /kg collected) between pegfilgrastim 6 mg (early administration) and filgrastim 5 µg/kg/day (147 participants; risk ratio (RR) 0.87, 95% confidence interval (95%CI) 0.67-1.11; P = .26). Pooling data from three studies shows no difference in the incidence of adverse events between pegylated and non-pegylated G-CSF (170 participants; RR 0.86, 95%CI 0.34-2.17; P = .75). No difference found on the quantity of CD34+ cells collected, number of apheresis procedure in successful mobilization, level of peak PB CD34+ cells achieved, and day of neutrophil and platelet engraftment.
Collapse
Affiliation(s)
- Jew W Kuan
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Sarawak, Malaysia
| | - Anselm T Su
- Department of Community Medicine and Public Health, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Sarawak, Malaysia
| | - Chooi F Leong
- Department of Pathology, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| |
Collapse
|
8
|
Kuan JW, Su AT, Leong CF, Tharyan P. Pegylated granulocyte colony stimulating factor versus non-pegylated granulocyte colony stimulating factor for peripheral stem cell mobilization. Hippokratia 2016. [DOI: 10.1002/14651858.cd010103.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jew-Win Kuan
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak; Department of Medicine; 94300 Kota Samarahan Sarawak Malaysia
| | - Anselm Ting Su
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak; Department of Community Medicine and Public Health; 94300 Kota Samarahan Sarawak Malaysia
| | - Chooi-Fun Leong
- University Kebangsaan Malaysia Medical Center; Department of Pathology; Jalan Yaakob Latif Kuala Lumpur Wilayah Persekutuan Malaysia 56000
| | - Prathap Tharyan
- Christian Medical College; Cochrane South Asia, Prof. BV Moses Center for Evidence-Informed Health Care and Health Policy; Carman Block II Floor CMC Campus, Bagayam Vellore Tamil Nadu India 632002
| |
Collapse
|
9
|
A randomized double blind control trial comparing filgrastim and pegfilgrastim in cyclophosphamide peripheral blood hematopoietic stem cell mobilization. Transfus Apher Sci 2015; 53:196-204. [DOI: 10.1016/j.transci.2015.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 03/18/2015] [Accepted: 03/23/2015] [Indexed: 11/22/2022]
|
10
|
Schirm S, Engel C, Loeffler M, Scholz M. Modelling chemotherapy effects on granulopoiesis. BMC SYSTEMS BIOLOGY 2014; 8:138. [PMID: 25539928 PMCID: PMC4302124 DOI: 10.1186/s12918-014-0138-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/11/2014] [Indexed: 02/05/2023]
Abstract
Background Although the growth-factor G-CSF is widely used to prevent granulotoxic side effects of cytotoxic chemotherapies, its optimal use is still unknown since treatment outcome depends on many parameters such as dosing and timing of chemotherapies, pharmaceutical derivative of G-CSF used and individual risk factors. We showed in the past that a pharmacokinetic and –dynamic model of G-CSF and human granulopoiesis can be used to predict the performance of yet untested G-CSF schedules. However, only a single chemotherapy was considered so far. In the present paper, we propose a comprehensive model of chemotherapy toxicity and combine it with our cell kinetic model of granulopoiesis. Major assumptions are: proportionality of cell numbers and cell loss, delayed action of chemotherapy, drug, drug-dose and cell stage specific toxicities, no interaction of drugs and higher toxicity of drugs at the first time of application. Correspondingly, chemotherapies can be characterized by a set of toxicity parameters which can be estimated by fitting the predictions of our model to clinical time series data of patients under therapy. Data were either extracted from the literature or were received from cooperating clinical study groups. Results Model assumptions proved to be feasible in explaining granulotoxicity of 10 different chemotherapeutic drugs or drug-combinations applied in 33 different schedules with and without G-CSF. Risk groups of granulotoxicity were traced back to differences in toxicity parameters. Conclusion We established a comprehensive model of combined G-CSF and chemotherapy action in humans which allows us to predict and compare the outcome of alternative G-CSF schedules. We aim to apply the model in different clinical contexts to optimize and individualize G-CSF treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12918-014-0138-7) contains supplementary material, which is available to authorized users.
Collapse
|
11
|
Storaas E, Holmaas G, Gravdal K, Børretzen A, Eikesdal HP. Lethal pneumonitis after docetaxel chemotherapy: case report and review of the literature. Acta Oncol 2013; 52:1034-8. [PMID: 23244676 DOI: 10.3109/0284186x.2012.750734] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
12
|
Delarue R, Tilly H, Mounier N, Petrella T, Salles G, Thieblemont C, Bologna S, Ghesquières H, Hacini M, Fruchart C, Ysebaert L, Fermé C, Casasnovas O, Van Hoof A, Thyss A, Delmer A, Fitoussi O, Molina TJ, Haioun C, Bosly A. Dose-dense rituximab-CHOP compared with standard rituximab-CHOP in elderly patients with diffuse large B-cell lymphoma (the LNH03-6B study): a randomised phase 3 trial. Lancet Oncol 2013; 14:525-33. [DOI: 10.1016/s1470-2045(13)70122-0] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
13
|
Santini D, Frezza AM, Venditti O, Intagliata S, dell'Aquila E, Guida F, Vincenzi B, Tonini G, Silvestris N, Brunetti AE, Guarini A, Del Re M, Danesi R, Cinieri S. Comment and reply on: Pegfilgrastim is safe and effective in the prevention of neutropenia and treatment delays in biweekly regimens. Expert Opin Ther Targets 2013; 17:473-4. [DOI: 10.1517/14728222.2013.773269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
14
|
Kuan JW, Su AT, Leong CF. Pegylated granulocyte colony stimulating factor versus non-pegylated granulocyte colony stimulating factor for patients after hematopoietic stem cell transplantation. Hippokratia 2012. [DOI: 10.1002/14651858.cd010104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jew-Win Kuan
- Ampang Hospital; Department of Haematology; Jalan Mewah Utara, Pandan Mewah Ampang Selangor Malaysia 68000
| | - Anselm Ting Su
- University of Malaya; Julius Center University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine; Lembah Pantai Kuala Lumpur Wilayah Persekutuan Malaysia 50603
| | - Chooi-Fun Leong
- University Kebangsaan Malaysia Medical Center; Department of Pathology; Jalan Yaakob Latif Kuala Lumpur Wilayah Persekutuan Malaysia 56000
| |
Collapse
|
15
|
Huntington SF, Talbott MS, Greer JP, Morgan DS, Reddy N. Toxicities and outcomes among septuagenarians and octogenarians with diffuse large B-cell lymphoma treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone therapy. Leuk Lymphoma 2012; 53:1461-8. [PMID: 22260160 DOI: 10.3109/10428194.2012.658793] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The diagnosis of non-Hodgkin lymphoma (NHL) is increasingly common among the elderly and it is well recognized that this patient population may benefit from therapy. No guidelines exist for chemotherapy dosing in the elderly population, and a clear assessment of treatment toxicity and benefits has not been previously reported. In this single-institution study, we report the toxicities and treatment outcomes of septuagenarians and octogenarians with large cell lymphoma treated with chemo-immunotherapy with or without radiation, as primary therapy with curative intent. We identified 37 patients over the age of 70 years diagnosed with large cell lymphoma treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) and compared their experience with 65 patients aged less than 70 years. Our retrospective analysis suggests that elderly patients are more susceptible to treatment-related toxicity despite more frequent chemotherapy dose reductions and greater utilization of supportive care. While our aged patients experienced greater frequency of hospitalization during R-CHOP treatment, the vast majority were able to receive relative chemotherapy dose-intensity greater than 70% and experienced similar rates of complete remission.
Collapse
Affiliation(s)
- Scott F Huntington
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37135, USA
| | | | | | | | | |
Collapse
|
16
|
Yang BB, Savin MA, Green M. Prevention of Chemotherapy-Induced Neutropenia with Pegfilgrastim: Pharmacokinetics and Patient Outcomes. Chemotherapy 2012; 58:387-98. [DOI: 10.1159/000345626] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 11/05/2012] [Indexed: 12/21/2022]
|
17
|
Klastersky J, Gombos A, Georgala A, Awada A. Prevention of neutropenia-related events in elderly patients with hematological cancer. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.11.69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The aging of the population makes it necessary to define more precisely the needs of elderly patients in terms of anticancer therapy as the number of older cancer patients is expected to increase. There is evidence that many elderly cancer patients can benefit from relatively aggressive treatments, provided major side effects can be prevented or treated. In patients with hematological malignancies, infection is the most common and threatening complication resulting from chemotherapy administration. Discussion of the prevention of infection in the setting described above is the aim of this paper.
Collapse
Affiliation(s)
| | - Andrea Gombos
- Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger-Bordet 1, 1000 Brussels, Belgium
| | - Aspasia Georgala
- Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger-Bordet 1, 1000 Brussels, Belgium
| | - Ahmad Awada
- Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger-Bordet 1, 1000 Brussels, Belgium
| |
Collapse
|
18
|
Saloustros E, Tryfonidis K, Georgoulias V. Prophylactic and therapeutic strategies in chemotherapy-induced neutropenia. Expert Opin Pharmacother 2011; 12:851-63. [PMID: 21254862 DOI: 10.1517/14656566.2011.541155] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Neutropenia poses a serious threat to patients on chemotherapy. It exposes them to the risk of infection--including potentially fatal infections--and also leads to delays in treatment and reductions in dose intensity, which can compromise the possibility of a favorable outcome. AREAS COVERED The use of granulocyte colony-stimulating factors (G-CSF) and antibiotics to prevent febrile neutropenia (FN) and to ameliorate cancer chemotherapy-induced myelosuppression is discussed, based on a systematic search of Pubmed for clinical trials, reviews and meta-analysis published in the last 20 years. We consider that the treatment of FN, with the emphasis on careful attention to the patient, prompts antibiotic therapy and good hospital care. EXPERT OPINION We would argue that antibiotic prophylaxis should be offered routinely to patients receiving cytotoxic chemotherapy for acute leukemia and for patients with solid tumors and lymphoma receiving high-dose chemotherapy. In patients undergoing cyclical standard-dose myelosuppressive chemotherapy, we believe that prophylaxis is indicated during the first cycle of chemotherapy in which there is an expectation of grade 4 neutropenia (< 500 neutrophils). However, although the use of antibiotics and haematopoietic growth factors may improve quality of life by reducing the risk and consequences of FN, further study of the magnitude of their effects is needed.
Collapse
Affiliation(s)
- Emmanouil Saloustros
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | | | | |
Collapse
|
19
|
Pettengell R, Schwenkglenks M, Bacon P, Lawrinson S, Duehrsen U. Pegfilgrastim primary prophylaxis in patients with non-Hodgkin lymphoma: results from an integrated analysis. Hematol Oncol 2011; 29:177-84. [DOI: 10.1002/hon.982] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 11/02/2010] [Accepted: 12/13/2010] [Indexed: 11/07/2022]
|
20
|
Aapro MS, Bohlius J, Cameron DA, Dal Lago L, Donnelly JP, Kearney N, Lyman GH, Pettengell R, Tjan-Heijnen VC, Walewski J, Weber DC, Zielinski C. 2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours. Eur J Cancer 2010; 47:8-32. [PMID: 21095116 DOI: 10.1016/j.ejca.2010.10.013] [Citation(s) in RCA: 746] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 10/18/2010] [Indexed: 10/18/2022]
Abstract
Chemotherapy-induced neutropenia is a major risk factor for infection-related morbidity and mortality and also a significant dose-limiting toxicity in cancer treatment. Patients developing severe (grade 3/4) or febrile neutropenia (FN) during chemotherapy frequently receive dose reductions and/or delays to their chemotherapy. This may impact the success of treatment, particularly when treatment intent is either curative or to prolong survival. In Europe, prophylactic treatment with granulocyte-colony stimulating factors (G-CSFs), such as filgrastim (including approved biosimilars), lenograstim or pegfilgrastim is available to reduce the risk of chemotherapy-induced neutropenia. However, the use of G-CSF prophylactic treatment varies widely in clinical practice, both in the timing of therapy and in the patients to whom it is offered. The need for generally applicable, European-focused guidelines led to the formation of a European Guidelines Working Party by the European Organisation for Research and Treatment of Cancer (EORTC) and the publication in 2006 of guidelines for the use of G-CSF in adult cancer patients at risk of chemotherapy-induced FN. A new systematic literature review has been undertaken to ensure that recommendations are current and provide guidance on clinical practice in Europe. We recommend that patient-related adverse risk factors, such as elderly age (≥65 years) and neutrophil count be evaluated in the overall assessment of FN risk before administering each cycle of chemotherapy. It is important that after a previous episode of FN, patients receive prophylactic administration of G-CSF in subsequent cycles. We provide an expanded list of common chemotherapy regimens considered to have a high (≥20%) or intermediate (10-20%) risk of FN. Prophylactic G-CSF continues to be recommended in patients receiving a chemotherapy regimen with high risk of FN. When using a chemotherapy regimen associated with FN in 10-20% of patients, particular attention should be given to patient-related risk factors that may increase the overall risk of FN. In situations where dose-dense or dose-intense chemotherapy strategies have survival benefits, prophylactic G-CSF support is recommended. Similarly, if reductions in chemotherapy dose intensity or density are known to be associated with a poor prognosis, primary G-CSF prophylaxis may be used to maintain chemotherapy. Clinical evidence shows that filgrastim, lenograstim and pegfilgrastim have clinical efficacy and we recommend the use of any of these agents to prevent FN and FN-related complications where indicated. Filgrastim biosimilars are also approved for use in Europe. While other forms of G-CSF, including biosimilars, are administered by a course of daily injections, pegfilgrastim allows once-per-cycle administration. Choice of formulation remains a matter for individual clinical judgement. Evidence from multiple low level studies derived from audit data and clinical practice suggests that some patients receive suboptimal daily G-CSFs; the use of pegfilgrastim may avoid this problem.
Collapse
Affiliation(s)
- M S Aapro
- Multidisciplinary Oncology Institute, Clinique de Genolier, 1, route du Muids, 1272 Genolier, Switzerland.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Aapro M, Crawford J, Kamioner D. Prophylaxis of chemotherapy-induced febrile neutropenia with granulocyte colony-stimulating factors: where are we now? Support Care Cancer 2010; 18:529-41. [PMID: 20191292 PMCID: PMC2846279 DOI: 10.1007/s00520-010-0816-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 01/07/2010] [Indexed: 11/23/2022]
Abstract
Updated international guidelines published in 2006 have broadened the scope for the use of granulocyte colony-stimulating factor (G-CSF) in supporting delivery of myelosuppressive chemotherapy. G-CSF prophylaxis is now recommended when the overall risk of febrile neutropenia (FN) due to regimen and individual patient factors is >or=20%, for supporting dose-dense and dose-intense chemotherapy and to help maintain dose density where dose reductions have been shown to compromise outcomes. Indeed, there is now a large body of evidence for the efficacy of G-CSFs in supporting dose-dense chemotherapy. Predictive tools that can help target those patients who are most at risk of FN are now becoming available. Recent analyses have shown that, by reducing the risk of FN and chemotherapy dose delays and reductions, G-CSF prophylaxis can potentially enhance survival benefits in patients receiving chemotherapy in curative settings. Accumulating data from 'real-world' clinical practice settings indicate that patients often receive abbreviated courses of daily G-CSF and consequently obtain a reduced level of FN protection. A single dose of PEGylated G-CSF (pegfilgrastim) may provide a more effective, as well as a more convenient, alternative to daily G-CSF. Prospective studies are needed to validate the importance of delivering the full dose intensity of standard chemotherapy regimens, with G-CSF support where appropriate, across a range of settings. These studies should also incorporate prospective evaluation of risk stratification for neutropenia and its complications.
Collapse
Affiliation(s)
- Matti Aapro
- IMO Clinique de Genolier, 1272 Genolier, Switzerland.
| | | | | |
Collapse
|
22
|
|
23
|
Morishita M, Leonard RC. Pegfilgrastim; a neutrophil mediated granulocyte colony stimulating factor–expanding uses in cancer chemotherapy. Expert Opin Biol Ther 2008; 8:993-1001. [DOI: 10.1517/14712598.8.7.993] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
24
|
Piedbois P, Serin D, Priou F, Laplaige P, Berdah JF, Grenier J. Reply to Letter to the editor, by Ishiguro et al. (Ann Oncol). Ann Oncol 2008. [DOI: 10.1093/annonc/mdn053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|