Managing neutropenia by pegfilgrastim in patients affected by relapsed/refractory multiple myeloma treated with bendamustine-bortezomib-dexamethasone

A phase I study of different doses and frequencies of pegylated recombinant human granulocyte-colony stimulating factor (PEG rhG-CSF) in patients with standard-dose chemotherapy-induced neutropenia

“…Previous studies indicated that the efficacy and safety of the dosage of PEG rhG-CSF in one chemotherapy cycle at 6 mg was well compared with 11 daily injections of rhG-CSF at 5 μg/kg/d in treating neutropenia (8)(9)(10)(11)(12). In addition, single dose of 100 μg/kg PEG rhG-CSF also displayed the similar protection function compared with daily rhG-CSF injection in patients receiving myelo-suppressive chemotherapy regimens (11,13,14). However, most patients who received standard dose of chemotherapy seldom experience severe myelosuppression but need daily injections of rhG-CSF in routine clinical practice.…”

Infections in Patients with Multiple Myeloma in the Era of Novel Agents and Stem Cell Therapies

“…FN is a serious effect of chemotherapy, and it has the following adverse consequences: delay in administration of scheduled therapies, costs of hospitalization, and increased risk of morbidity and mortality in immunocompromised individuals [58]. Several studies have shown that the following risk factors for neutropenia and FN in patients with MM: (1) heavily pretreated disease and relapsed and refractory (R/R)-MM, (2) elderly patients with comorbid medical conditions, and (3) use of the following drugs particularly in combination with other agents such as lenalidomide, bendamustine, and the combination of bendamustine, bortezomib and dexamethasone [55,[58][59][60].…”

“…Management of patients with prolonged neutropenia and FN includes: (1) thorough physical evaluation for the site or source of infection, (2) taking enough cultures and septic screens, (3) administration of prophylactic and empirical antimicrobials, and (4) pre-emptive or prophylactic administration of granulocyte-colony stimulating factor (G-CSF) in patients who are expected to have prolonged or severe neutropenia [58,59]. However, the choice of empirical antibiotic therapy in patients with HMs having FN depends on the risk stratification of the individual patient [61,62].…”

“…In addition, recombinant G-CSF is commonly used to reduce the incidence, duration, and severity of FN [57]. Studies have shown that the use of G-CSF as primary prophylaxis improves quality of life, is cost-effective as it reduces the: days of hospitalization, infectious complications, and incidence of chemotherapy interruptions [58,59].…”

A case of efficacy of bendamustine in heavily pretreated multiple myeloma, refractory to pomalidomide

“…In February 2016, a seventh-line salvage treatment was performed employing bendamustine, bortezomib, dexamethasone (BVD: bendamustine 90 mg/sqm IV days 1 and 2, bortezomib 1.3 mg/mq s.c. days 1, 4, 8, 11, dexamethasone 20 mg oral solution/IV days 1,2,4,5,8,9,11,12 and pegfilgrastim 6 mg s.c. day 4, every 28 days) [5] with the unexpected result of a VGPR, achieved after only one course of treatment, and reduction of more than 90% of urinary K chain concentration and dramatic shrinkage of the abdominal tumor mass. Unfortunately, the patient died before the second course due to progressive cachexia.…”