Bendamustine and G-CSF support

Excerpt

We read the manuscript by Cerchione C et al. with particular interest [1]. The use of peg-filgrastim in patients treated with bendamustine in terms of the timing of filgrastim/peg-filgrastim is concerning. Prolonged neutropenia is sometimes anticipated during bendamustine chemotherapy. Cerchione C et al. reported the clinical benefits of peg-filgrastim as the primary prophylaxis for neutropenia [1]. This manuscript reported reduced neutropenic episodes and reduced febrile neutropenia (with or without documented infection) in patients treated with peg-filgrastim compared to those in the control group who were treated with filgrastim. This finding was hypothesized to reduce overall chemotherapy disruptions. We can acknowledge the importance of relative dose intensity (RDI) in the treatment of malignant lymphoma, which is supported by significant evidence. RDI is associated with a higher remission rate and better survival [2]. However, the relationship between RDI and survival in patients receiving bendamustine treatment and R-CHOP has not yet been fully revealed. In addition, grade 3–4 neutropenia occurred in only 44% of patients in a phase II study conducted by Czuczman MS et al. [3]. Grade 3–4 febrile neutropenia was observed in 6.1% of patients in another phase II study [4]. Thus, we might consider using peg-filgrastim in a “secondary-prophylaxis” manner, according to the risk assessment of the NCCN Clinical Practice Guidelines (NCCN guidelines®) for myeloid growth factors. …