The Effect of Pegylated Granulocyte-Colony Stimulating Factor (GCSF; Pegfilgrastim, Neulasta ®) administration timing in relation to the CHOP or CHOP-like regimen administration timing in Non-Hodgkin's Lymphoma (NHL) patients on development of neutropenia

The administration of G-CSF (Pegfilgrastim) has been associated with a reduction of neutropenia in patients receiving myelosuppressive regimens; hence it is part of the standard of care to support those patients. However its administration timing in relation to the regimen administration remains controversial.

Objectives:

The aim of this study was to assess the effect of administration timing of the Pegfilgrastim on the development of neutropenic episodes in relation to CHOP-like regimens administration timing in patients with NHL.

Methods:

The study was a retrospective analysis to patients' records who were admitted to Hollywood Private Hospital during January 2010 to March 2011. Twenty four patients aged between 55-75 with NHL received Pegfilgrastim immediately after CHOP-like chemotherapy (D1, Group A) or after 24 hours post treatment (D2, Group B) were included in the study. Those patients received a total of 117 cycles of CHOP-like regimen followed by Pegfilgrastim. Group A had 60 pt-cycles and group B had 57 pt-cycles with similar demographics. Any neutropenia (ANC<1.5x 10⁹ Cell/cc), febrile neutropenia (ANC) <0.5x 10⁹ Cell/cc with temperature 38° C or above), infectious episodes and related hospital admissions were documented.  The frequency of these episodes between the two groups was then analysed.

Results:

Total number of neutropenic episodes for all the patients in Group A was 16 (26.7%) episodes compared with 6 (10.5%) episodes for Group B which were statistically significant (p = 0.033). The number of episodes of febrile neutropenia were 8 (13.3%) and 2 (3.5%) for group A and B respectively (p=0.095). The number of hospital admissions due to neutropenia, febrile illnesses and infections were significantly lower in Group B compared to Group A (3.5% vs 13.3% respectively, p=0.025).

Conclusion:

We conclude that the administration timing of Pegfilgrastim in relation to the administration of the CHOP-like regimen in NHL patients is crucial and should be at least 24 hours post treatment and NOT immediately post chemotherapy to reduce the risk of neutropenia and hospital admission.