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Randomized, Multicenter, Open-Label Study of Pegfilgrastim Compared With Daily Filgrastim After Chemotherapy for Lymphoma

From the University of Nebraska Medical Center, Omaha, NE; Princess Margaret Hospital, Toronto, Canada; University Hospitals of Cleveland, Cleveland, OH; University of California Los Angeles Medical Center, Los Angeles, and Amgen Inc, Thousand Oaks, CA; New England Medical Center, Boston, MA; Duke University Medical Center, Durham, NC; and University of Maryland Medical Center and Johns Hopkins Hospital, Baltimore, MD.

Address reprint requests to Julie M. Vose, MD, Department of Internal Medicine, University of Nebraska Medical Center, 987680 Nebraska Medical Center, Omaha, NE 68198; email: jmvose{at}unmc.edu.

Purpose: The primary objective was to assess the duration of grade 4 neutropenia (neutrophil count < 0.5 x 10⁹/L) after one cycle of chemotherapy with etoposide, methylprednisolone, cisplatin, and cytarabine in patients randomly assigned to receive one dose of pegfilgrastim or daily filgrastim after chemotherapy. Febrile neutropenia, neutrophil profiles, time to neutrophil recovery, pharmacokinetics, and safety were also assessed.

Patients and Methods: An open-label, randomized, phase II study was designed to compare the effects of a single subcutaneous injection of pegfilgrastim (sustained-duration filgrastim) 100 µg/kg per chemotherapy cycle (n = 33) with daily subcutaneous injections of filgrastim 5 µg/kg (n = 33) in patients receiving salvage chemotherapy for relapsed or refractory Hodgkin’s or non-Hodgkin’s lymphoma.

Results: The incidence of grade 4 neutropenia in the pegfilgrastim and filgrastim groups was 69% and 68%, respectively. In addition, the mean duration of grade 4 neutropenia was similar in both groups (2.8 and 2.4 days, respectively). The results for the two groups were also not significantly different for febrile neutropenia, neutrophil profile, time to neutrophil recovery, or toxicity profile. A single subcutaneous injection of pegfilgrastim 100 µg/kg produced a sustained serum concentration relative to daily subcutaneous injections of filgrastim. Filgrastim-treated patients received a median of 11 injections per cycle.

Conclusion: Pegfilgrastim was safe and well tolerated in this patient population. A single injection of pegfilgrastim per chemotherapy cycle provided neutrophil support with safety and efficacy similar to that provided by daily injections of filgrastim. Once-per-cycle administration of pegfilgrastim simplifies the management of neutropenia and may have important clinical benefits for patients and healthcare providers.

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