Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Autografting

Retrospective comparison of the effects of filgrastim and pegfilgrastim on the pace of engraftment in auto-SCT patients

Bone Marrow Transplantation volume 45, pages 1522–1527 (2010)Cite this article

Subjects

Abstract

The high doses of chemotherapy used for the preparatory regimens before autologous blood or marrow stem cell transplantation leave patients at risk for neutropenic complications. The administration of filgrastim post transplant reduces the time to neutrophil recovery and therefore has become a standard practice at many institutions. In 2006, we implemented a practice change from filgrastim to pegfilgrastim. We present data on 164 consecutive patients (82 patients who received filgrastim compared with 82 patients who received pegfilgrastim) who received an auto-SCT between January 2006 and November 2007. Patients who received pegfilgrastim had faster engraftment (9.6 days compared with 10.9 days, P<0.0001), a lower incidence of febrile neutropenia (59% compared with 78%, P=0.015), as well as shorter hospital stay, fewer days of treatment with i.v. antibiotics (6.3 days compared with 9.6 days, P=0.006), and fewer radiographic tests, which translated to an estimated total cost savings of over $8000 per patient. Overall, there were no differences in toxicity with these two agents. We conclude that a single dose of pegfilgrastim is a safe and efficacious alternative to daily injections of filgrastim and can be a cost-effective approach in auto-SCT patients.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Afessa B, Peters SG . Major complications following hematopoietic stem cell transplantation. Semin Respir Crit Care Med 2006; 27: 297–309.

    Article  PubMed  Google Scholar 

  2. Hamalainen S, Kuittinen T, Matinlauri I, Nousiainen T, Koivula I, Jantunen E . Severe sepsis in autologous stem cell transplant recipients: microbiological aetiology, risk factors and outcome. Scand J Infect Dis 2009; 41: 14–20.

    Article  CAS  PubMed  Google Scholar 

  3. Mossad SB, Longworth DL, Goormastic M, Serkey JM, Keys TF, Bolwell BJ . Early infectious complications in autologous bone marrow transplantation: a review of 219 patients. Bone Marrow Transplant 1996; 18: 265–271.

    CAS  PubMed  Google Scholar 

  4. Richard S, Schuster MW . Stem cell transplantation and hematopoietic growth factors. Curr Hematol Rep 2002; 1: 103–109.

    PubMed  Google Scholar 

  5. Trivedi M, Martinez S, Corringham S, Medley K, Ball ED . Optimal use of G-CSF administration after hematopoietic SCT. Bone Marrow Transplant 2009; 43: 895–908.

    Article  CAS  PubMed  Google Scholar 

  6. Bhana N . Granulocyte colony-stimulating factors in the management of chemotherapy-induced neutropenia: evidence based review. Curr Opin Oncol 2007; 19: 328–335.

    Article  CAS  PubMed  Google Scholar 

  7. Hornedo J, Sola C, Solano C, Lopez JJ, Alonso S, Lluch A et al. The role of granulocyte colony-stimulating factor (G-CSF) in the post-transplant period. Bone Marrow Transplant 2002; 29: 737–743.

    Article  CAS  PubMed  Google Scholar 

  8. Lee SM, Radford JA, Dobson L, Huq T, Ryder WD, Pettengell R et al. Recombinant human granulocyte colony-stimulating factor (filgrastim) following high-dose chemotherapy and peripheral blood progenitor cell rescue in high-grade non-Hodgkin's lymphoma: clinical benefits at no extra cost. Br J Cancer 1998; 77: 1294–1299.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Smith TJ, Khatcheressian J, Lyman GH, Ozer H, Armitage JO, Balducci L et al. 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol 2006; 24: 3187–3205.

    Article  CAS  PubMed  Google Scholar 

  10. Crawford J . Once-per-cycle pegfilgrastim (Neulasta) for the management of chemotherapy-induced neutropenia. Semin Oncol 2003; 30 (4 Suppl 13): 24–30.

    Article  CAS  PubMed  Google Scholar 

  11. Molineux G . Pegfilgrastim: using pegylation technology to improve neutropenia ssupport in cancer patients. Anticancer Drugs 2003; 14: 259–264.

    Article  CAS  PubMed  Google Scholar 

  12. Yowell SL, Blackwell S . Novel effects with polyethylene glycol modified pharmaceuticals. Cancer Treat Rev 2002; 28 (Suppl A): 3–6.

    Article  CAS  PubMed  Google Scholar 

  13. Martino M, Pratico G, Messina G, Irrera G, Massara E, Console G et al. Pegfilgrastim compared with filgrastim after high-dose melphalan and autologous hematopoietic peripheral blood stem cell transplantation in multiple myeloma patients. Eur J Haematol 2006; 77: 410–415.

    Article  CAS  PubMed  Google Scholar 

  14. Staber PB, Holub R, Linkesch W, Schmidt H, Neumeister P . Fixed-dose single administration of Pegfilgrastim vs daily Filgrastim in patients with haematological malignancies undergoing autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 2005; 35: 889–893.

    Article  CAS  PubMed  Google Scholar 

  15. Jagasia MH, Greer JP, Morgan DS, Mineishi S, Kassim AA, Ruffner KL et al. Pegfilgrastim after high-dose chemotherapy and autologous peripheral blood stem cell transplant: phase II study. Bone Marrow Transplant 2005; 35: 1165–1169.

    Article  CAS  PubMed  Google Scholar 

  16. Vanstraelen G, Frere P, Ngirabacu MC, Willems E, Fillet G, Beguin Y . Pegfilgrastim compared with Filgrastim after autologous hematopoietic peripheral blood stem cell transplantation. Exp Hematol 2006; 34: 382–388.

    Article  CAS  PubMed  Google Scholar 

  17. Porrata LF, Gertz MA, Inwards DJ, Litzow MR, Lacy MQ, Tefferi A et al. Early lymphocyte recovery predicts superior survival after autologous hematopoietic stem cell transplantation in multiple myeloma or non-Hodgkin lymphoma. Blood 2001; 98: 579–585.

    Article  CAS  PubMed  Google Scholar 

  18. Yoong Y, Porrata LF, Inwards DJ, Ansell SM, Micallef IN, Litzow MR et al. The effect of absolute lymphocyte count recovery kinetics on survival after autologous stem cell transplantation for non-Hodgkin's lymphoma. Leuk Lymphoma 2005; 46: 1287–1294.

    Article  PubMed  Google Scholar 

  19. Hiwase DK, Hiwase S, Bailey M, Bollard G, Schwarer AP . Higher infused lymphocyte dose predicts higher lymphocyte recovery, which in turn, predicts superior overall survival following autologous hematopoietic stem cell transplantation for multiple myeloma. Biol Blood Marrow Transplant 2008; 14: 116–124.

    Article  PubMed  Google Scholar 

  20. Ballestrero A, Boy D, Gonella R, Miglino M, Clavio M, Barbero V et al. Pegfilgrastim compared with filgrastim after autologous peripheral blood stem cell transplantation in patients with solid tumours and lymphomas. Ann Hematol 2008; 87: 49–55.

    Article  PubMed  Google Scholar 

  21. AMCP Guide to Pharmaceutical Payment Methods. Update (Version 2.0). J Manag Care Pharm 2009; 15 (Suppl A): S3–S57 (quiz S58–S61).

    Google Scholar 

Download references

Acknowledgements

We thank all of the dedicated staff involved in the outstanding care of the patients undergoing auto-SCT at Memorial Hospital. We also thank Kris Kauffman for his time and contributions in data collection and management.

Author information

Author notes

  1. R L Comenzo

    Present address: 6Current address: Tufts Medical Centre, Boston, MA, USA,

  2. T Kewalramani

    Present address: 7Current address: Lahey Clinic, Burlington, MA, USA,

Authors and Affiliations

  1. Department of Pharmacy, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    S Mathew, N Adel & S D Nimer

  2. Department of Nursing, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    R D Rice

  3. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    K Panageas

  4. Department of Finance, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    E T Duck

  5. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    R L Comenzo & T Kewalramani

Authors
  1. S Mathew
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N Adel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R D Rice
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K Panageas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E T Duck
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R L Comenzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. T Kewalramani
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. S D Nimer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S Mathew.

Ethics declarations

Competing interests

Dr Stephen Nimer has received honorarium from Amgen for serving as a consultant. Dr Nelly Adel has served as a speaker for several continuous education programs sponsored by grants from Amgen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mathew, S., Adel, N., Rice, R. et al. Retrospective comparison of the effects of filgrastim and pegfilgrastim on the pace of engraftment in auto-SCT patients. Bone Marrow Transplant 45, 1522–1527 (2010). https://doi.org/10.1038/bmt.2009.373

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2009.373

Keywords

This article is cited by

Search

Advanced search

Quick links