Pegylated Filgrastim Is Comparable with Filgrastim As Support for Autologous Hematopoietic Stem Cell Transplantation

Objetives

G-CSF has shown to shorten time to neutrophil engraftment in autologous peripheral blood hematopoietic stem cell transplantation (Auto-HSCT). Two filgrastim pharmacological presentations exist for clinical use, non-pegylated and pegylated. Our aim was to compare clinical outcomes in using as support Peg-Filgrastim (PEG-F)or Filgrastim (F) in a group of adults undergoing autologous HSCT.

Methods

From 2010 to 2012, 69 adult patients underwent Auto-HSTC in our BMT unit. Attending physician decided the allocation to PEG-F or F. Other support measures were standardized in all patients. An independent reviewer collected data from medical records. Descriptive analyses were carried-out as well as Kaplan-Meier survival estimates.

Results

From 69 included subjects, 50 received PEG-F and 19 F. Median age was 46 vs 54 for PEG-F vs. F (P=0.05). There was no difference by gender, body weight, diagnoses, conditioning regimen, or CD34+ cells infused. Most common diagnoses were Multiple Myeloma (48%) and Hodgkin lymphoma (28%). In concordance with diagnoses, Melphalan (52%) and BEAM (46%) were the conditioning regimens most commonly used. Median CD34+ (x106)/Kg preserved were 4.3 for PEG-F vs. 3.9 for F, (P=0.61). Median initiation of PEG-F was 7 days after cell infusion compared to 3 days for F; P<0.01. We did not have transplant mortality death. Neutropenic fever was equal among groups (58% vs 47%). Median number of days to achieve 500 neutrophils was 12 vs 11 (PEG-F vs F); P<0.01. All patients showed neutrophil and platelet engraftment.

Conclusions

We did not find clinically relevant differences among the effects of the two pharmacological filgrastim presentations. We also found that 4 day difference in starting the drug only represented 1 day of delay in neutrophil engraftment without clinical repercussions. Now, we considered changing our clinical practice by introducing PEG-F for all patients, taking into consideration ease of application and economical consideration.