Low-dose filgrastim significantly enhances neutrophil recovery following autologous peripheral-blood stem-cell transplantation in patients with lymphoproliferative disorders: evidence for clinical and economic benefit.

Abstract

Low-dose filgrastim significantly reduces neutrophil engraftment time post-PBSCT and also reduces in-patient stay and costs, which makes it economically viable for patients who are undergoing high-dose chemotherapy.

Optimal use of G-CSF administration after hematopoietic SCT

“…21 Three studies used a BSAbased dosing for filgrastim (50 mg/m 2 per day) or lenograstim (150 mg/m 2 per day), 11,17,27 whereas Lee et al 23 used a fixed dose of filgrastim (300 mg per day) in patients who weighed 70 kg or less and a weight-based dose (5 mg/kg per day) in patients heavier than 70 kg. The criteria for discontinuing G-CSF treatment after PBSCT differed significantly in various studies: when ANC 4500/ ml, 11,20,27 ANC 41000/ml, 21,22 ANC 41500/ml, 16,24 ANC 45000/ml, 19 or WBC 410 000/ml; 25 or after ANC 4500/ml for 2 28 or 3 17,26,29,30 consecutive days; or after ANC 41000/ ml for 2 consecutive days; 23 or after WBC 41000/ml for 3 consecutive days; 18 or was left to the treating physician. 10 Various PBSC mobilization protocols, conditioning regimens and prophylaxis therapies were used in these studies.…”

“…Various studies have evaluated the efficacy of using G-CSF in comparison to either placebo 11,16,17 or observation. 10,[18][19][20][21][22][23][24][25][26][27][28][29][30] These studies are summarized in Tables 1-3.…”

“…In most of the studies, ANC 4500/ml was achieved by day þ 9 to day þ 11 when G-CSF was used. The difference in days to neutrophil engraftment between the groups receiving or not receiving G-CSF ranged from 2 to 9.5 days, 10,11,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] showing that the use of G-CSF was beneficial in terms of earlier neutrophil engraftment. In addition, several studies noted that even though the high number of CD34 þ cells infused correlated with earlier neutrophil engraftment, the benefit of using G-CSF was independent of the number of CD34 þ cells infused.…”

“…24,[38][39][40][41] However, there was no significant difference in time to plts engraftment (plts 420 000/ml) between the group receiving G-CSF and the control group in most studies. 10,11,[17][18][19][20][21][22][23][24][25][26][27][28][29][30] Only one randomized, single-blind, placebo-controlled study showed a significant increase in plts engraftment when G-CSF was used (starting on day þ 5) compared with placebo. 16 As eight out of nine RCTs (o90%) with well over 100 patients in each group showed no significant difference in plts engraftment with the use of G-CSF, 10,11,17,[22][23][24]26,29 this was considered level 1B evidence.…”

“…[5][6][7][8][9] The use of G-CSF after HSCT accelerates granulocyte engraftment and recovery by 1-6 days in comparison with control. [10][11][12][13] However, most of the studies have been carried out on small numbers of patients and have varied significantly in patient demographics, G-CSF dosage regimen and other factors affecting outcomes. Overall, there is no consensus on the optimal use of G-CSF after high-dose chemotherapy followed by HSCT.…”