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PURPOSE: The objective of this study was to compare the time to engraftment of autologous hematopoietic stem cell transplant (HSCT) patients who received filgrastim on day +5 versus day +10. In addition, number of febrile days, antibiotic use, documented infection, and length of hospitalization were compared. We hypothesized that duration of neutropenia and incidence of neutropenic fever would be similar in patients who received filgrastim on day +5 versus day +10.
METHODS: Prior to initiation, the study received approval from the Institutional Review Board. A HSCT database was used to identify patients who have received autologous HSCT from January 1, 2007 to June 30, 2013. Patients were included if they received filgrastim on day +5 + 1 or day +10 + 1 post HSCT. Patients were matched based on age + 5 years and type of malignancy. The health-system’s electronic medical record system, HSCT database, and medication charts were used to collect the following data: age, gender, weight, height, type of malignancy requiring transplant, date of autologous HSCT, chemotherapy conditioning regimen, filgrastim and antibiotic administration, documented infections, length of stay, and survival.
RESULTS: There were 79-matched pairs that met inclusion criteria. The day +5 group had an average time to engraftment of 8.27 days compared to 8.96 days in the day +10 group (p=0.006). All secondary endpoints were similar between both groups, including rates of infection and total febrile days. There was no difference seen with average length of stay between the two groups (p=0.745).
CONCLUSION: The average time to engraftment was statistically significant, in favor of patients who received filgrastim earlier in their transplant course on day +5. However the primary and secondary endpoints results are not clinically significant. Future directions include a cost analysis to assess economic outcomes.