127 Abstract 5410: Dose-Escalated G-CSF Does Not Improve Resolution of Neutropenia Compared to Standard-Dose G-CSF Following Autologous Stem Cell Transplantation

Track: BMT Pharmacists Conference
Friday, February 13, 2015, 1:45 PM-3:00 PM
Harbor Ballroom DEF (Manchester Grand Hyatt)
Steven Trifilio, BSPharm , Northwestern Memorial Hospital, Chicago, IL
Jessica l Fong , Northwestern Memorial Hospital, Chicago, IL
Cindy Zhao , Northwestern Memorial Hospital, Chicago, IL
Junyu Zhang , Northwestern Memorial Hospital, Chicago, IL
Derek Liu , Northwestern Memorial Hospital, Chicago, IL
Marcelo Villa, BS MT(ASCP) , Cell Therapy Processing Facility, Northwestern Memorial Hospital, Chicago, IL
Jayesh Mehta, MD , Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
Presentation recording not available for download or distribution as requested by the presenting author.

Granulocyte colony stimulating factors (G-CSF, Filgrastim, Neupogen) are routinely used after autologous HSCT to reduce the duration of severe neutropenia. Clinical studies have not  directly compared the effects of  different G-CSF doses on engraftment, thus the optimal G-CSF dose remains unknown.  A clinical initiative of  dose-escalated GCSF was instituted at NMH to determine if  the duration of neutropenia could be reduced with increased G-CSF dose.  Herein are the results of an observational study comparing standard dose to dose-escalated G-CSF for resolution of neutropenia following auto-HSCT.

NMH electronic database was used to identify  consecutive autologous HSCT recipients treated at Northwestern Memorial Hospital between 2008-9 (single daily dose Filgrastim 5mcg/kg) and  2010-11 (twice daily dose  of  Filgrastim-total dose=10mcg/kg/day) All patients started G-CSF 5 days after stem cell infusion .Resolution of neutropenia was defined as the 1st day  ANC > 500cells/ml. Most patients  received a minimum of 5mcg/kg/dose total body weight rounded up to the nearest vial size. 

172  single-dose and 162  twice daily dose auto-HSCT recipients were included in this study. There was no statistical difference between study arms for age, weight, gender, diagnosis, or G-CSF dose, the number of  patients who received a 480mcg doses of G-CSF. The number  of CD34+ stem cells infused was significantly higher in the twice daily study arm.

Table 2 shows study results. Time to engraftment and the number of treatment days needed to reach engraftment was the same for both study arms. No difference was observed for length of stay or hospital mortality. A trend towards higher microbiologically confirmed infections was seen.

In this study, a single 5mcg/kg G-CSF dose was as effective as twice daily 5mcg/kg G-CSF doses for  accelerating stem cell engraftment. A randomized prospective study is needed to confirm these results.

 

TABLE 1. Single  vs  Twice Daily G-CSF

Demographics

Single Daily Dose  

Twice Daily Dose

P-value

Number

172

163

 Age (range)

56(22-77)

57(24-77)

0.4343

Weight (median/kg)

82.77

85.43

0.2228

G-CSF dose (mcg/kg)

148(86)

1622

0.4955

Male

101(59)

120(66)

0.8711

Diagnosis

Myeloma

135(78)

136(75)

0.3787

NHL

24(14)

24(13)

0.877

Other

13(8)

22(12)

0.2199

CD34 cells infused(mean-mil/kg)

6.03

6.72

0.0395

 

Table 2    Results

Single

Twice daily

P-value

Time to engraftment (days)

12(9-27)

11(9-24)

0.9126

Length of stay (range)

16(7-45)

16(9-115)

0.4777

Number of patients with microbiologically confirmed infection

26

42

0.0787

Hospital mortality

3(1.7)

4(2.2)

0 99

 

 

Disclosures:
Nothing To Disclose
Presentations
  • Best Abstract 5410-Dose-Escalated G-CSF...Neutropenia_2015 BMT Pharmacists Conference.pdf (124.7 kB)