Résumé
Abstract 3410
Poster Board III-298
Granulocyte colony-stimulating factor (G-CSF) has been shown to decrease time to neutrophil recovery following PBSCT. Now, 3 products are available: 2 standard G-CSFs (filgrastim and lenograstim), and pegfilgrastim (PegG-CSF). In order to determine whether a single subcutaneous injection of Peg-G-CSF is as effective as a daily injection of standard G-CSF, in terms of haematological recovery, febrile neutropenic episodes (FN), antibiotic usage, hospitalization duration, mucositis, progressive free survival (PFS) and overall survival (OS), we retrospectively analyzed series of 558 patients having myeloma and lymphoma who underwent 683 PBSCT between 2000 and 2008 in our institution. Statistical analysis included univariate, Wilcoxon and χ2 fisher tests, logrank test for PFS and OS, and Cox model for multivariate analysis. From January 2000 and April 2005, 359 patients received standard G-CSF (filgrastim or lenograstim) and from May 2005 to December 2008, 298 patients received PegG-CSF. 26 patients did not receive G-CSF for any reasons. 427 PBSCTs have been performed for multiple myeloma (MM) after high dose melphalan, 197 for Non Hodgkin Lymphoma (NHL) and 59 for Hodgkin lymphoma (HL) with BEAM conditioning regimen. 133 patients underwent 2 or 3 PBSCT (130 MM and 3 HL). The mean of CD34 dose infused was 5.2 106 /kg (1.2-26.9) with 96% of the grafts containing more than 2.5 106 CD34/Kg. The median number of days of standard G-CSF given to reach an absolute neutrophil count (ANC) ≥500/ml was 9 days (0-29). Median time to neutrophil engraftment (ANC of 500/ml) was 11 days (5-30) in each group. The platelet recovery (platelet>20 000/mL) was 10 days (0-54) in each group. The platelet and RBC transfusion requirement are stastitically lower in the PegG-CSF than in the standard G-CSF group. As listed on the table, we have analyzed the following parameters for all patients: number of FN and their beginning and duration, number of antibiotic lines, duration of hospitalization, duration of mucositis, and the percentage of grade III and IV mucositis.
Median, (range) Peg G-CSF standard G-CSF None G-CSF N 298 359 p 26 FN rate (%) 91.7 96.4 <0.01 96.16 Duration of FN (days) 2 (0-27) 2 (0-18) 0.62 2 (0-13) First day of FN (day) 5 (-3-16) 4 (-5-17) <0.01 4 (0-11) Number of antibiotic lines 1 (1-5) 2 (0-5) <0.01 3 (0-4) Duration of hospitalization (days) 17 (8-62) 19 (8-65) <0.01 24 (18-35) Duration of mucositis (days) 0 (0-75) 6 (0-60) <0.01 7.5 (0-10) Mucositis grade III, IV (%) 17.7 40.28 <0.01 ND
The same significantly differences are observed in MM, NHL and HL patients. The use of standard G-CSF or PegG-CSF did not modify OS at 1 and 5 years for both NHL and HL patients. In MM population PFS was unmodified but OS appeared better in the PegG-CSF group compared to standard G-CSF: respectively 1 y OS at 1 year, 96% versus 92%, OS at 5 years: 79% versus 53% (p= 0.034). Such a difference could be explained by the early use of bortezomib regimen for induction therapy before PBSCT more frequently in PegG-CSF group and this feature has been analyzed. Among patients undergoing autologous stem cell transplantation the use of Peg G-CSF seems to show an advantage in terms of duration of hospitalization and reduce the percentage of grade III, IV mucositis and the number of febrile neutropenic episodes.