Single-dose pegfilgrastim is comparable to daily filgrastim in mobilizing peripheral blood stem cells: a case-matched study in patients with lymphoproliferative malignancies

Abstract

To cite this version:Mervi Putkonen, Auvo Rauhala, Tarja-Terttu Pelliniemi, Kari Remes. Single-dose pegfilgrastim is comparable to daily filgrastim in mobilizing peripheral blood stem cells: a case-matched study in patients with lymphoproliferative malignancies. Annals of Hematology, Springer Verlag, 2009, 88 Abstract Pegfilgrastim (PEGFIL) has been found to be comparable to daily filgrastim (FIL) in managing chemotherapy-induced neutropenia. In the present study, we evaluated the ability of PEGFIL to mobilize stem cells in 38 consecutive patients with lymphoproliferative diseases (multiple myeloma, n=18; lymphomas, n=15; chronic lymphocytic leukemia, n=5). Patients were mobilized using PEGFIL (6-18 mg as a single dose) during [2005][2006]; 32 then received high-dose chemotherapy followed by autologous stem cell transplantation. PEGFIL-mobilized patients were matched by age, disease, and treatment line at a ratio of 1:2 to historical FIL-mobilized controls. The primary study endpoint was the blood CD34 + concentration at onset of leukapheresis. Leukapheresis began a median of 10 days from the beginning of mobilization chemotherapy in both groups. At the onset of leukapheresis, median blood CD34 + cell counts did not differ significantly in the FIL group compared with the PEGFIL group (79×10 6 /L vs 64×10 6 /L, respectively; p=0.44). In the different disease categories, the respective CD34 + cell counts after FIL and PEGFIL mobilization were 72×10 6 /L vs 123×10 6 /L (p=0.08) in myeloma, 51×10 6 /L vs 62×10 6 /L (p=0.6) in lymphomas, and 27×10 6 /L vs 30×10 6 /L (p=0.62) in CLL, respectively.The target CD34 + cell yield was harvested with one leukapheresis in 53% of PEGFIL-mobilized patients. Engraftment after autografting did not differ significantly in the two groups. Stem cell mobilization with a single dose of PEGFIL was, therefore, comparable to that achieved using daily FIL in patients with lymphoproliferative diseases. PEGFIL is a more practical way to mobilize stem cells than daily FIL.

Pegfilgrastim vs filgrastim in PBSC mobilization for autologous hematopoietic SCT: a systematic review and meta-analysis

“…Apheresis was initiated when a CD34+ cell count of ⩾ 7-20 × 10 6 cells/L or a circulating WBC count of ⩾ 4 × 10 9 cells/L was reached, as described in the study method. Pegfilgrastim mobilized groups showed an earlier apheresis onset time when compared with filgrastim in four studies, but showed no difference in two studies (Putkonen et al 16 and Simona et al 39 ). Pooled results showed that pegfilgrastim mobilization resulted in a significant reduction in time to first apheresis (SDM: − 0.512, 95% CI: − 0.973 to − 0.050; P = 0.030) (Figure 3a).…”

“…Although some have demonstrated that the use of pegfilgrastim results in an earlier apheresis start and reduction in the number of apheresis procedures required for PBSC collection, others have failed to show such a benefit. [14][15][16] Data for total CD34+ cell collection yield and neutrophil recovery rate post HSCT have been conflicting as well. 16,17 As the literature presents inconclusive results, we performed a systematic review and meta-analysis of studies comparing PBSC mobilization outcomes of pegfilgrastim with filgrastim as part of a chemo-cytokine mobilization regimen.…”

Clinical impact and resource utilization after stem cell mobilization failure in patients with multiple myeloma and lymphoma

“…Typical strategies for stem cell mobilization include the use of filgrastim alone, 12 filgrastim plus pegfilgrastim, 13,14 sargramostim, 15,16 or filgrastim combined with conventional chemotherapy, 17 with apheresis commencing on recovery of the leukocyte count. In a significant proportion of patients receiving standard filgrastim, a requisite number of CD34 þ cells can not be collected because of factors such as age, 18,19 extent of prior chemotherapy, 20,21 and exposure to specific medications including melphalan, 22 purine nucleoside analogs, 23,24 and lenalidomide.…”

Pegfilgrastim compared with filgrastim for cytokine-alone mobilization of autologous haematopoietic stem and progenitor cells

“…Indeed, much of the data regarding cytokine-alone mobilization using filgrastim comes from the healthy allogeneic donor setting where these requirements are paramount. Pegylated filgrastim for cytokine-only mobilization has the theoretical advantage of improved kinetics if it is able to smooth out the peaks and troughs of PB CD34 þ cells that are seen in filgrastim dosing, 37,38 plus the potential for increased acceptability to the patient given its single-dose administration.…”