A randomized, double-blind trial of pegfilgrastim versus filgrastim for the management of neutropenia during CHASE(R) chemotherapy for malignant lymphoma

Br J Haematol. 2016 Aug;174(4):563-70. doi: 10.1111/bjh.14088. Epub 2016 Apr 12.

Abstract

Pegfilgrastim is a pegylated form of the granulocyte-colony stimulating factor, filgrastim. Herein, we report the results of a multicentre, randomized, double-blind phase III trial comparing the efficacy and safety of pegfilgrastim with filgrastim in patients with malignant lymphoma. Patients were randomized to receive either a single subcutaneous dose of pegfilgrastim or daily subcutaneous doses of filgrastim on day 4 after the completion of cyclophosphamide, cytarabine, etoposide and dexamethasone ± rituximab (CHASE(R); day 1-3) chemotherapy. The primary endpoint was the duration of severe neutropenia (DSN), defined as the number of days with neutrophil count <0·5 × 10(9) /l in the first cycle of chemotherapy. A total of 111 lymphoma patients were randomized to either the pegfilgrastim or filgrastim group. 109 patients received either pegfilgrastim (n = 54) or filgrastim (n = 55). Efficacy data were available for 107 patients (pegfilgrastim: n = 53, filgrastim: n = 54). Both groups were well balanced in terms of gender, age, performance status and other variables. The mean DSN (±S.D.) was 4·5 (±1·2) and 4·7 (±1·3) d in the pegfilgrastim and filgrastim groups. No significant difference in safety was observed. This trial verified the non-inferiority of a single subcutaneous dose of pegfilgrastim compared with daily subcutaneous doses of filgrastim, considering DSN as an indicator.

Keywords: CHASE(R) chemotherapy; G-CSF; febrile neutropenia; malignant lymphoma; pegfilgrastim.

Publication types

  • Clinical Trial, Phase III
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Cyclophosphamide / adverse effects
  • Cyclophosphamide / therapeutic use
  • Cytarabine / adverse effects
  • Cytarabine / therapeutic use
  • Dexamethasone / adverse effects
  • Dexamethasone / therapeutic use
  • Disease Management
  • Double-Blind Method
  • Etoposide / adverse effects
  • Etoposide / therapeutic use
  • Female
  • Filgrastim / administration & dosage*
  • Granulocyte Colony-Stimulating Factor / administration & dosage*
  • Humans
  • Lymphoma / complications
  • Lymphoma / drug therapy*
  • Male
  • Middle Aged
  • Neutropenia / chemically induced
  • Neutropenia / drug therapy*
  • Polyethylene Glycols
  • Recombinant Proteins / administration & dosage
  • Rituximab / adverse effects
  • Rituximab / therapeutic use
  • Young Adult

Substances

  • Recombinant Proteins
  • Cytarabine
  • Granulocyte Colony-Stimulating Factor
  • pegfilgrastim
  • Polyethylene Glycols
  • Rituximab
  • Etoposide
  • Dexamethasone
  • Cyclophosphamide
  • Filgrastim

Supplementary concepts

  • CHASE protocol