Secondary Prophylactic G-CSF (Filgrastim) Administration in Chemotherapy of Stage I and II Hodgkin's Lymphoma with ABVD

Rueda, Antonio; Sevilla, Isabel; Gumà, Josep; Ribelles, Nuria; Miramón, José; Nieves, M; Márquez, Antonia; Alba, Emilio

doi:10.3109/10428190109057990

Cited by 15 publications

(4 citation statements)

References 20 publications

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“…This compares with results from the Skoetz meta-analysis, in which patients treated with BEACOPP ESC vs ABVD had a statistically significant increase in neutropenia (p < 0.0001) [6]. Risk of neutropenia can be managed using G-CSF [125], which in our review ranged from use as primary prophylaxis [19] and use with certain treatments such as BEACOPP ESC [84], to secondary prophylaxis for patients with severe neutropenia [39]. ABVD and BEACOPP may also be associated with side effects not identified in this review.…”

Section: Discussionmentioning

confidence: 64%

“…In the ECHELON-1 trial comparing A +AVD and ABVD, the incidence of neutropenia was 58% and 45%, respectively, and febrile neutropenia was 19% and 8%, respectively [64]. Granulocyte-colony stimulating factor (G-CSF) can be administered to manage the risk of neutropenia [125]. G-CSF use in the included studies varied from use as primary prophylaxis from Day 8 of treatment [19], obligatory use for certain treatments such as BEACOPP ESC [84], and secondary prophylaxis reserved for patients with severe neutropenia [39].…”

Section: Secondary Malignanciesmentioning

confidence: 99%

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Efficacy and safety of front-line treatments for advanced Hodgkin lymphoma: a systematic literature review

Dalal

Gupta²,

Price³

et al. 2020

Expert Review of Hematology

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Objective: To assess evidence on the safety and efficacy of ABVD (doxorubicin [Adriamycin®], bleomycin, vinblastine, and dacarbazine), BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), and A+AVD (brentuximab vedotin, with doxorubicin, vinblastine, and dacarbazine) for advanced-stage Hodgkin lymphoma (HL). Methods: A systematic literature review (SLR) was conducted on 29 July 2016 (updated 26 July 2018) to identify randomized controlled trials (RCTs) and non-RCTs assessing the treatment of newly-diagnosed advanced-stage HL with ABVD and BEACOPP (and their variants), and A+AVD. Results: The SLR identified 62 RCTs and 42 non-RCTs. Five-year overall survival rates for ABVD and BEACOPP were 60-97% and 84-99%, and 5-year progression-free survival rates were 58-81% and 83-96%, respectively. Both regimens were associated with tolerability issues and side effects. Discontinuation or dose reduction of bleomycin resulted in fewer adverse events, without significantly affecting efficacy. A head-to-head trial demonstrated improved efficacy for A+AVD vs ABVD, with an acceptable tolerability profile. No data from head-to-head trials comparing A+AVD with BEACOPP were available, and an indirect treatment comparison was not feasible. Conclusion: New therapies, such as A+AVD, maintain the efficacy observed with current treatments, and may provide a more tolerable treatment option for patients with advanced-stage HL.

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Section: Discussionmentioning

confidence: 64%

Section: Secondary Malignanciesmentioning

confidence: 99%

Efficacy and safety of front-line treatments for advanced Hodgkin lymphoma: a systematic literature review

Dalal

Gupta²,

Price³

et al. 2020

Expert Review of Hematology

View full text Add to dashboard Cite

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“…Treatment strategies include either dose reduction or treatment delay, or use of G-CSF to maintain dose-intensity, although data to support this recommendation (G-CSF with ABVD) are lacking (Silvestri et al, 1994;Rueda et al, 2001). Investigators at the University of Iowa reported a 43% rate of significant haematological toxicity with ABVD treatment (Chand et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

G‐CSF is not necessary to maintain over 99% dose–intensity with ABVD in the treatment of Hodgkin lymphoma: low toxicity and excellent outcomes in a 10‐year analysis

Evens

Cilley

Ortiz³

et al. 2007

Br J Haematol

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SummaryDose–intensity of chemotherapy is important in the treatment of Hodgkin lymphoma (HL) and granulocyte‐colony stimulating factor (G‐CSF) is commonly used to maintain it. We reviewed all newly diagnosed HL patients who were treated at our institution between 1996 and 2005. Fifty‐nine patients received adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy with no dose reductions, treatment delays, and without G‐CSF, regardless of absolute neutrophil count (ANC). The median ANC on all ABVD treatment days (n = 658) was 0·925 × 109/l, and was <0·5 × 109/l on 26% of treatment days. Median normalised ABVD dose–intensity was 99·1% (range, 93–100%) and median cycle duration was 28·2 d. Incidence of bleomycin lung toxicity was 1·6%, 0·44% treatments were complicated by febrile neutropenia, and no secondary malignancies have occurred (median follow‐up 48 months; range, 11–130 months). Five‐year event‐free (EFS) and overall survival (OS) were 92·9% and 97·4% respectively. Furthermore, the 5‐year EFS and OS (87·4% and 94·1% respectively) for advanced stage patients compared favourably with a similar ABVD patient group who received routine prophylactic G‐CSF (n = 23) with EFS 80·0% and OS 91·3% (P = 0·46 and 0·67 respectively). Our experience suggests that ABVD may be safely and effectively administered at >99% dose–intensity without G‐CSF support, regardless of the ANC.

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“…Although the association with filgrastim has not been noted by others, most clinicians try to limit the amounts of filgrastim used in these patients based on this finding. The use of filgrastim or pegfilgrastim at all with ABVD is controversial [36–39], although filgrastim support is standard with more intensive regimens like escalated and dose‐intense BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone) [40].…”

Section: Pulmonary Toxicity With Abvdmentioning

confidence: 99%

Chemotherapy only for localized Hodgkin lymphoma

Straus

2011

Journal of Internal Medicine

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Radiation therapy (RT) alone and more recently in combination with chemotherapy (combined modality therapy; CMT) has been the cornerstone of curative treatment for early-stage Hodgkin lymphoma (HL) for over 40 years. Because of increasing awareness of the late morbidity and mortality associated with RT, recent treatment regimens have attempted to limit its use. Chemotherapy only has been demonstrated to be a treatment option for most patients with localized HL. Current clinical trials have targeted subgroups of such patients who may be at an increased risk of recurrence for the addition of limited RT to chemotherapy.

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Secondary Prophylactic G-CSF (Filgrastim) Administration in Chemotherapy of Stage I and II Hodgkin's Lymphoma with ABVD

Abstract: Secondary prophylactic G-CSF administration was necessary in more than half of patients with stage I or II Hodgkin's lymphoma during chemotherapy with ABVD. The use of G-CSF allowed maintenance of chemotherapy schedule and dose intensity in the majority of patients.

Cited by 15 publications

References 20 publications

Efficacy and safety of front-line treatments for advanced Hodgkin lymphoma: a systematic literature review

Efficacy and safety of front-line treatments for advanced Hodgkin lymphoma: a systematic literature review

G‐CSF is not necessary to maintain over 99% dose–intensity with ABVD in the treatment of Hodgkin lymphoma: low toxicity and excellent outcomes in a 10‐year analysis

Chemotherapy only for localized Hodgkin lymphoma

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