Same-day pegfilgrastim or pegfilgrastim-cbqv prophylaxis in miniCHOP chemotherapy based regimens for non-Hodgkin lymphoma.

Abstract

e19542 Background: Non-Hodgkin’s lymphoma, specifically, diffuse large B-cell lymphoma (DLBCL) is most frequently diagnosed among older patients. The utilization of a reduced dose of cyclophosphamide, doxorubicin, vincristine, and prednisone (miniCHOP) chemotherapy-based regimen has an improved tolerance and toxicity profile in select patient populations. Prophylaxis with pegfilgrastim or its biosimilar pegfilgrastim-cbqv is administration on the same day of chemotherapy in all patients with MiniCHOP at The University of Arizona Cancer Center (UACC). We report here on the first study to address the safety and efficacy of same day pegfilgrastim administration in lymphoma patients receiving MiniCHOP. Methods: A retrospective, single center, cohort study was conducted at UACC between October 1, 2013 and October 2020 to evaluate lymphoma patients who were treated with miniR-CHOP and given pegfilgrastim or its biosimilar (pegfilgrastim-cbqv) for FN prophylaxis. The primary objective was to compare the incidence of FN across all cycles of chemotherapy and after the first cycle of chemotherapy in DLBCL patients on miniR-CHOP and provided with next-day versus same-day pegfilgrastim administration. Our secondary outcomes of interests were incidence of chemotherapy-induced neutropenia (CIN) grade 3/4; hospitalization; anti-biotics administration; and chemotherapy dose-reduction or delays. Results: A total of 100 cycles of miniR-CHOP were received, of these pegfilgrastim was administered on same-day of chemotherapy in 95 cycles and five cycles on the next-day of chemotherapy. Among all cycles the incidence of FN was 5.3% vs. 0.0 ( P= 1.00); CIN 3/4 was 10.5% vs. 0.0 ( P= 1.00); hospitalization was 10.5% vs. 20.0% ( P= 0.45), anti-biotics administration was 6.3% vs. 40.0% ( P= 0.05) and the chemotherapy dose delays or reductions was 16.8% vs. 0.0% ( P= 0.99). In the first cycle of chemotherapy, the incidence of FN was 14.3% vs. 0.0% ( P= 1.00), CIN 3/4 was 21.4% vs. 0.0 ( P= 1.00), hospitalization 28.6% vs. 25.0% ( P= 0.99), and the anti-biotics administration was 21.4% vs. 50.0% ( P= 0.53) for same-day vs. next-day study groups. Conclusions: In our analysis, we have shown that same-day pegfilgrastim or pegfilgrastim-cbqv was safe and effective in lymphoma patients receiving miniR-CHOP. There was no significant increase in FN or delayed engraftment in either group. Future prospective studies are warranted to address the safety and efficacy profile of same day pegfilgrastim or a pegfilgrastim biosimilars in elderly lymphoma patients.

A prospective study to evaluate febrile neutropenia incidence in patients receiving pegfilgrastim on-body injector vs other choices

“…Similarly, another recent systematic review with meta-analysis showed a significantly higher FN rate in patients administered same-day prophylaxis compared with those receiving next-day prophylaxis both in the first cycle (odds ratio [OR] = 2.56, 95% CI, 1.19–5.48, p = 0.02) and across all cycles (OR = 1.54, 95% CI, 1.29–1.84, p < 0.00001) [ 32 ]. At the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting, 3 small (< 120 patients) retrospective analyses evaluated same-day administration of prefilled syringe all studies showed increased rates of FN with same-day administration [ 33 – 35 ]. Pegfilgrastim, when used as indicated, decreases chemotherapy-induced FN.…”

Meta-Analysis of Same-Day Pegfilgrastim Administration Stratified by Myelotoxic Febrile Neutropenia Risk and Tumor Type

“…Observational ( Athar et al, 2007 ; Bartels et al, 2021 ; Bilen et al, 2017 ; Billingsley et al, 2015 ; Cheng et al, 2014 ; Eckstrom et al, 2019 ; Gupta et al, 2007 ; Hoffmann, 2005 ; Ibrahim et al, 2011 ; Karol et al, 2013 ; Kumar et al, 2009 ; Lokich, 2005 ; Lokich, 2006 ; Matera et al, 2017 ; McBride et al, 2021 ; Micha et al, 2013 ; Schuman et al, 2009 ; Skarlos et al, 2009 ; Vance & Carpenter, 2006 ; Weycker et al, 2017 ; Whitworth et al, 2009 ; Woods et al, 2010 ) and randomized studies ( Burris et al, 2010 ; Siefker-Radtke et al, 2016 ) have evaluated the extent of prophylaxis provided by a single dose of pegfilgrastim administered within the first 24 hours after completion of chemotherapy. Here, we present a meta-analysis of studies comparing the efficacy of same-day pegfilgrastim to the standard protocol of administration > 24 hours following completion of chemotherapy (next-day).…”