Clinical effect of prophylactic pegfilgrastim in patients with newly diagnosed acute lymphoblastic leukemia who receive intensive chemotherapy

• Published in: Supportive care in cancer 2024-11, Vol.32 (11), p.715, Article 715
• Main Authors: Lee, Yunji, Jang, Youngeun, Lee, Jung Min, Cho, Hee Jeong, Moon, Joon Ho, Sohn, Sang Kyun, Ham, Ji Yeon, Chang, Soon Hee, Baek, Dong Won
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Chemotherapy; Clinical outcomes; Dexamethasone - administration & dosage; Dexamethasone - therapeutic use; Female; Filgrastim - administration & dosage; Filgrastim - therapeutic use; Granulocyte Colony-Stimulating Factor - administration & dosage; Granulocyte Colony-Stimulating Factor - therapeutic use; Hospitalization; Humans; Induction therapy; Leukemia; Male; Medicine; Medicine & Public Health; Middle Aged; Neutropenia; Neutropenia - chemically induced; Neutropenia - prevention & control; Nursing; Nursing Research; Oncology; Pain Medicine; Polyethylene Glycols - administration & dosage; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Recombinant Proteins - administration & dosage; Recombinant Proteins - therapeutic use; Rehabilitation Medicine; Retrospective Studies; Young Adult
• ISSN: 0941-4355; 1433-7339; 1433-7339
• DOI: 10.1007/s00520-024-08926-0

Background Using granulocyte colony-stimulating factor (G-CSF) after completing chemotherapy reduces the duration of neutropenia and infections. However, the efficacy and safety of prophylactic pegfilgrastim in acute lymphoblastic leukemia (ALL) patients have not yet been evaluated after intensive cytotoxic chemotherapy compared to the daily G-CSF. This study aimed to evaluate the efficacy of pegfilgrastim for ALL patients who received intensive chemotherapy compared with a short-acting G-CSF. Patients and methods Clinical data of 145 patients treated with hyper-CVAD, modified VPDL/VPD, or KALLA 1406/1407 regimen were retrospectively evaluated. Pegfilgrastim or the short-acting G-CSF was selected according to the clinician’s discretion. Patients not receiving pegfilgrastim were treated with the short-acting G-CSF. Results The median age of enrolled patients was 45 years. Sixty newly diagnosed ALL patients were treated with hyper-CVAD regimen, while KALLA and VPDL regimens were administered to 39 and 46 patients, respectively. Among the 60 patients treated with hyper-CVAD, 20 patients received pegfilgrastim. Patients who received pegfilgrastim had a significantly shorter duration of neutropenia and hospitalization and reduced incidence of severe infections compared to patients receiving the short-acting G-CSF. Consistent results were also confirmed in an analysis targeting only patients who achieved remission during hyper-CVAD induction therapy. There was no significant difference in neutrophil recovery ability and hospitalization duration when the daily short-acting G-CSF was used prophylactically after completing hyper-CVAD, KALLA, and VPDL regimens as induction therapy. Conclusion Using pegfilgrastim after hyper-CVAD therapy was more effective than the short-acting G-CSF in terms of infection, neutropenia recovery, and hospitalization in patients with newly diagnosed ALL.