A retrospective analysis of the effect of Filgrastim compared to pegfilgrastim on neutrophil recovery during the treatment of acute leukaemias

Abstract

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ObjeetivesThc rale of neutrophil recovery is a crucial parameter for successful treatment of acute leukaemias. Traditionally, filgrastim, which is a short acting Granulocyte Colony Stimulating Factor (G-CSF ) is used to reduce the period of posl-chemoiherapy neutropenia. It needs daily administration. The recently developed pegfilgrastim is a. long acting G-CSF that has decreased renal clearance allowing for single injection dosing. The objective was to compare the effect of filgrastim to pegfilgrastim on post chemotherapy neutrophil recovery'. Methods: We retrospectively analysed the outcome of 103-episodes of chemotherapy in 33 patients who received induction and consolidation therapy for acute leukaemias with supporting G-CSF during the period from 200" to 2009 at "a single institution. 24 patients were treated for AML and 9 for ALL/lymphoblastic lymphoma, G-CSF was commenced according to body weigh* (filgrastin 5mcgkg daily, pegfilgrastin 6mg, single dose) one day after completion of the chemotherapy. The time required for neutrophil recovery > 0.5x 10 "/l and > l.Ox 10 'T were analysed for each patient for every treatment cycle. The study also incorporated oiher factors that may influence neutrophil recovery such as ECOG status of the- patient, type of chemotherapy and the presence of febrile neutropaenia or sepsis. Results: Patients who were treated with filgrastim (IS patients) had a neutrophil recovery >0.5'nl with a mean of i 1 days compared to 12 days with pegfilgrastin. while neutrophil recovery >1.0/nl was observed on a mean of 12.5 days for both groups. There was no significant difference between the two groups with a p-valuc of 0.7 and 0.9 respectively. Further sub-analysis of induction and consolidation chemotherapies did not reveal a significant difference between the two cytokines, however it was noted that a prolonged neutropaenia occurred during induction- compared to consolidation chemotherapy in both treatment groups. Furthermore cost of the total course, of filgrastim was three times the cost of a single dose of pegfilgrastim. Conclusions: During the.treatment of acute leukaemia, pegfilgrastim results in a comparable effect with filgrastim with decreased cost and less injections.