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Hematopoietic Cell Collection

Pegfilgrastim vs filgrastim in PBSC mobilization for autologous hematopoietic SCT: a systematic review and meta-analysis

Bone Marrow Transplantation volume 50, pages 523–530 (2015)Cite this article

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Abstract

Trial outcomes comparing cytokine agents for PBSC mobilization in autologous hematopoietic transplant patients have been controversial. We performed a systematic review and meta-analysis of evidence available on pegfilgrastim vs filgrastim in chemo-cytokine mobilization. Electronic literature searches of PubMed, EMBASE and CENTRAL identified nine articles eligible for qualitative analysis with one randomized controlled trial. Eight articles involving 719 patients were included in the meta-analysis. Results showed similar CD34+ cell collection yields for pegfilgrastim and filgrastim (SDM −0.08, 95% CI: −0.388 to 0.228). On comparison with filgrastim, pegfilgrastim showed a significantly earlier apheresis onset time (SDM: −0.512, 95% CI: −0.973 to −0.050) and reduction in required apheresis procedures (SDM −0.260, 95% CI: −0.466 to −0.054). Times to leukocyte (⩾1.0 × 109/L) and platelet (⩾20 × 109/L) recovery were similar between groups (SDM: 0.015, 95% CI: −0.41 to 0.44 and SDM: 0.309, 95% CI: −0.11 to 0.72, respectively). Both agents were well tolerated and mild bone pain was the most frequently reported adverse event. Pegfilgrastim may be a convenient alternative to filgrastim in PBSC mobilization for multiple myeloma and lymphoma patients, but further studies are required to clarify effects of cytokine dosage and previous cytotoxic exposure in specific subpopulations.

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References

  1. To LB, Roberts MM, Haylock DN, Dyson PG, Branford AL, Thorp D et al. Comparison of haematological recovery times and supportive care requirements of autologous recovery phase peripheral blood stem cell transplants, autologous bone marrow transplants and allogeneic bone marrow transplants. Bone Marrow Transplant 1992; 9: 277–284.

    CAS  PubMed  Google Scholar 

  2. Korbling M, Champlin R . Peripheral blood progenitor cell transplantation: a replacement for marrow auto- or allografts. Stem Cells 1996; 14: 185–195.

    Article  CAS  PubMed  Google Scholar 

  3. Siena S, Bregni M, Brando B, Ravagnani F, Bonadonna G, Gianni AM . Circulation of CD34+ hematopoietic stem cells in the peripheral blood of high-dose cyclophosphamide-treated patients: enhancement by intravenous recombinant human granulocyte-macrophage colony-stimulating factor. Blood 1989; 74: 1905–1914.

    CAS  PubMed  Google Scholar 

  4. Demirer T, Buckner CD, Gooley T, Appelbaum FR, Rowley S, Chauncey T et al. Factors influencing collection of peripheral blood stem cells in patients with multiple myeloma. Bone Marrow Transplant 1996; 17: 937–941.

    CAS  PubMed  Google Scholar 

  5. Knudsen LM, Jensen L, Gaarsdal E, Nikolaisen K, Johnsen HE . A comparative study of sequential priming and mobilisation of progenitor cells with rhG-CSF alone and high-dose cyclophosphamide plus rhG-CSF. Bone Marrow Transplant 2000; 26: 717–722.

    Article  Google Scholar 

  6. Smith TJ, Khatcheressian J, Lyman GH, Ozer H, Armitage JO, Balducci L et al. 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol 2006; 24: 3187–3205.

    Article  CAS  PubMed  Google Scholar 

  7. Molineux G, Kinstler O, Briddell B, Hartley C, McElroy P, Kerzic P et al. A new form of Filgrastim with sustained duration in vivo and enhanced ability to mobilize PBPC in both mice and humans. Exp Hematol 1999; 27: 1724–1734.

    Article  CAS  PubMed  Google Scholar 

  8. Molineux G . Pegfilgrastim: using pegylation technology to improve neutropenia support in cancer patients. Anti-Cancer Drug 2003; 14: 259–264.

    Article  CAS  Google Scholar 

  9. Biganzoli L, Untch M, Skacel T, Pico JL . Neulasta (Pegfilgrastim): A once-per-cycle option for the management of chemotherapy-induced neutropenia. Semin Oncol 2004; 31: 27–34.

    Article  CAS  PubMed  Google Scholar 

  10. Hosing C, Qazilbash MH, Kebriaei P, Giralt S, Davis MS, Popat U et al. Fixed-dose single agent pegfilgrastim for peripheral blood progenitor cell mobilisation in patients with multiple myeloma. Br J Haematol 2006; 133: 533–537.

    Article  CAS  PubMed  Google Scholar 

  11. Isidori A, Tani M, Bonifazi F, Zinzani P, Curti A, Motta MR et al. Phase II study of a single pegfilgrastim injection as an adjunct to chemotherapy to mobilize stem cells into the peripheral blood of pretreated lymphoma patients. Haematologica 2005; 90: 225–231.

    CAS  PubMed  Google Scholar 

  12. Nosari A, Cairoli R, Ciapanna D, Gargantini L, Intropido L, Barate C et al. Efficacy of single dose pegfilgrastim in enhancing the mobilization of CD34+ peripheral blood stem cells in aggressive lymphoma patients treated with cisplatin-aracytin-containing regimens. Bone Marrow Transplant 2006; 38: 413–416.

    Article  CAS  PubMed  Google Scholar 

  13. Willis F, Woll P, Theti D, Jamali H, Bacon P, Baker N et al. Pegfilgrastim for peripheral CD34+ mobilization in patients with solid tumours. Bone Marrow Transplant 2009; 43: 927–934.

    Article  CAS  PubMed  Google Scholar 

  14. Bruns I, Steidl U, Kronenwett R, Fenk R, Graef T, Rohr UP et al. A single dose of 6 or 12 mg of pegfilgrastim for peripheral blood progenitor cell mobilization results in similar yields of CD34+progenitors in patients with multiple myeloma. Transfusion 2006; 46: 180–185.

    Article  CAS  PubMed  Google Scholar 

  15. Fruehauf S, Klaus J, Huesing J, Veldwijk MR, Buss EC, Topaly J et al. Efficient mobilization of peripheral blood stem cells following CAD chemotherapy and a single dose of pegylated G-CSF in patients with multiple myeloma. Bone Marrow Transplant 2007; 39: 743–750.

    Article  CAS  PubMed  Google Scholar 

  16. Putkonen M, Rauhala A, Pelliniemi TT, Remes K . Single-dose pegfilgrastim is comparable to daily filgrastim in mobilizing peripheral blood stem cells: a case-matched study in patients with lymphoproliferative malignancies. Ann Hematol 2009; 88: 673–680.

    Article  PubMed  Google Scholar 

  17. Tricot G, Jagannath S, Vesole D, Nelson J, Tindle S, Miller L et al. Peripheral blood stem cell transplants for multiple myeloma: identification of favorable variables for rapid engraftment in 225 patients. Blood 1995; 85: 588–596.

    CAS  PubMed  Google Scholar 

  18. Moher D, Liberati A, Tetzlaff J, Altman DG, Grp P . Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. PLoS Med 2009; 6: e1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M et al. The Newcastle-Ottawa Scale (NOS). In: Hospital Research Institute Ottawa (http://www.ohri.ca/programs/clinical_epidemiology/nosgen.pdf.

  20. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 Part 2: General methods for Cochrane reviews. In: JPT H, S G (eds). The Cochrane Collaboration 2011. http://handbook.cochrane.org/chapter_7/7_7_3_5_mediansand_interquartile_ranges.htm.

  21. Mantel N, Haenszel W . Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Institute 1959; 22: 719–748.

    CAS  Google Scholar 

  22. DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177–188.

    Article  CAS  PubMed  Google Scholar 

  23. Cochran WG . The combination of estimates from different experiments. Biometrics 1954; 10: 101–129.

    Article  Google Scholar 

  24. Kroschinsky F, Hoelig K, Platzbecker U, Schleyer E, Ordemann R, Haack A et al. Single-dose pegfilgrastim after chemotherapy is highly effective in enhancing the mobilization of autologous CD34+peripheral blood stem cells in patients with lymphoid malignancies and solid tumors. Blood 2004; 104: 798a–799a.

    Google Scholar 

  25. Zamboni WC . Pharmacokinetics of pegfilgrastim. Pharmacotherapy 2003; 23: 9S–14S.

    Article  CAS  PubMed  Google Scholar 

  26. Johnston E, Crawford J, Blackwell S, Bjurstrom T, Lockbaum P, Roskos L et al. Randomized, dose-escalation study of SD/01 compared with daily filgrastim in patients receiving chemotherapy. J Clin Oncol 2000; 18: 2522–2528.

    Article  CAS  PubMed  Google Scholar 

  27. Crawford J . Safety and efficacy of pegfilgrastim in patients receiving myelosuppressive chemotherapy. Pharmacotherapy 2003; 23: 15s–19s.

    Article  CAS  PubMed  Google Scholar 

  28. Bensinger W, Appelbaum F, Rowley S, Storb R, Sanders J, Lilleby K et al. Factors that influence collection and engraftment of autologous peripheral-blood stem cells. J Clin Oncol 1995; 13: 2547–2555.

    Article  CAS  PubMed  Google Scholar 

  29. Bruns I, Steid U, Fischer JC, Czibere A, Kobbe G, Raschke S et al. Pegylated G-CSF mobilizes CD34(+) cells with different stem and progenitor subsets and distinct functional properties in comparison with unconjugated G-CSF. Haematol-Hematol J 2008; 93: 347–355.

    Article  CAS  Google Scholar 

  30. Lambertini M, Del Mastro L, Bellodi A, Pronzato P . The five ‘Ws’ for bone pain due to the administration of granulocyte-colony stimulating factors (G-CSFs). Crit Rev Oncol/Hematol 2014; 89: 112–128.

    Article  Google Scholar 

  31. Green MD, Koelbl H, Baselga J, Galid A, Guillem V, Gascon P et al. A randomized double-blind multicenter phase III study of fixed-dose single-administration pegfilgrastim versus daily filgrastim in patients receiving myelosuppressive chemotherapy. Ann Oncol 2003; 14: 29–35.

    Article  CAS  PubMed  Google Scholar 

  32. Grigg A, Solal-Celigny P, Hoskin P, Taylor K, McMillan A, Forstpointner R et al. Open-label, randomized study of pegfilgrastim vs. daily filgrastim as an adjunct to chemotherapy in elderly patients with non-Hodgkin's lymphoma. Leukemia Lymphoma 2003; 44: 1503–1508.

    Article  CAS  PubMed  Google Scholar 

  33. Kuendgen A, Fenk R, Bruns I, Dommach M, Schutte A, Engers R et al. Splenic rupture following administration of pegfilgrastim in a patient with multiple myeloma undergoing autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 2006; 38: 69–70.

    Article  CAS  PubMed  Google Scholar 

  34. Donadieu J, Beaupain B, Rety-Jacob F, Nove-Josserand R . Respiratory distress and sudden death of a patient with GSDIb chronic neutropenia: possible role of pegfilgrastim. Haematologica 2009; 94: 1175–1177.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Szwajcer D, Jennings-Coutts A, Giftakis A, Wall DA . Identification of the CD34 enumeration on the day before stem cell harvest that best predicts poor mobilization. Transfusion 2011; 51: 587–590.

    Article  PubMed  Google Scholar 

  36. Richa E, Papari M, Allen J, Martinez G, Wickrema A, Anastasi J et al. Older age but not donor health impairs allogeneic granulocyte colony-stimulating factor (g-csf) peripheral blood stem cell mobilization. Biol Blood Marrow Transplant 2009; 15: 1394–1399.

    Article  CAS  PubMed  Google Scholar 

  37. Suzuya H, Watanabe T, Nakagawa R, Watanabe H, Okamoto Y, Onishi T et al. Factors associated with granulocyte colony-stimulating factor-induced peripheral blood stem cell yield in healthy donors. Vox Sang 2005; 89: 229–235.

    Article  CAS  PubMed  Google Scholar 

  38. Ford CD, Green W, Warenski S, Petersen FB . Effect of prior chemotherapy on hematopoietic stem cell mobilization. Bone Marrow Transplant 2004; 33: 901–905.

    Article  CAS  PubMed  Google Scholar 

  39. Simona B, Cristina R, Luca N, Sara S, Aleksandra B, Paola B et al. A single dose of Pegfilgrastim versus daily Filgrastim to evaluate the mobilization and the engraftment of autologous peripheral hematopoietic progenitors in malignant lymphoma patients candidate for high-dose chemotherapy. Transfusion Apheresis Sci 2010; 43: 321–326.

    Article  Google Scholar 

  40. Martin-Murea S, Voso MT, Hohaus S, Pforsich M, Fruehauf S, Goldschmidt H et al. The dose of granulocyte colony-stimulating factor administered following cytotoxic chemotherapy is not related to the rebound level of circulating CD34(+) haemopoietic progenitor cells during marrow recovery. Br J Haematol 1998; 101: 582–585.

    Article  CAS  PubMed  Google Scholar 

  41. Kobbe G, Sohngen D, Bauser U, Schneider P, Germing U, Thiele KP et al. Factors influencing G-CSF-mediated mobilization of hematopoietic progenitor cells during steady-state hematopoiesis in patients with malignant lymphoma and multiple myeloma. Ann Hematol 1999; 78: 456–462.

    Article  CAS  PubMed  Google Scholar 

  42. Hozo SP, Djulbegovic B, Hozo I . Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005; 5: 13.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Pardee TS, Hagag N, Singh B, Zamkoff KW, Locher E, Stevens M et al. Effective CD34+ stem cell mobilization with low-dose pegfilgrastim. J Appl Res 2006; 6: 196–200.

    CAS  Google Scholar 

  44. Russell N, Mesters R, Schubert J, Boogaerts M, Johnsen HE, Canizo CD et al. A phase 2 pilot study of pegfilgrastim and filgrastim for mobilizing peripheral blood progenitor cells in patients with non-Hodgkin's lymphoma receiving chemotherapy. Haematologica 2008; 93: 405–412.

    Article  CAS  PubMed  Google Scholar 

  45. Filgrastim: Drug information. In. UpToDate: Lexicomp 2014.

  46. Pegfilgrastim: Drug information. In. UpToDate: Lexicomp 2014.

  47. Steidl U, Fenk R, Bruns I, Neumann F, Kondakci M, Hoyer B et al. Successful transplantation of peripheral blood stem cells mobilized by chemotherapy and a single dose of pegylated G-CSF in patients with multiple myeloma. Bone Marrow Transplant 2005; 35: 33–36.

    Article  CAS  PubMed  Google Scholar 

  48. Ria R, Reale A, Melaccio A, Racanelli V, Dammacco F, Vacca A. . Filgrastim, lenograstim and pegfilgrastim in the mobilization of peripheral blood progenitor cells in patients with lymphoproliferative malignancies. Clin Exp Med 2014. [e-pub ahead of print].

  49. Tricot G, Barlogie B, Zangari M, van Rhee F, Hoering A, Szymonifka J et al. Mobilization of peripheral blood stem cells in myeloma with either pegfilgrastim or filgrastim following chemotherapy. Haematologica 2008; 93: 1739–1742.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This work was supported by BK21 Plus Program in 2014.

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Authors and Affiliations

  1. College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Gwanak-gu, Seoul, Korea

    M G Kim & N Han

  2. School of Pharmacy, Sungkyunkwan University, Suwon-si, Gyeonggi-do, Korea

    E-K Lee

  3. College of Pharmacy, Chonnam National University, Buk-gu, Gwangju, South Korea

    T Kim

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Kim, M., Han, N., Lee, EK. et al. Pegfilgrastim vs filgrastim in PBSC mobilization for autologous hematopoietic SCT: a systematic review and meta-analysis. Bone Marrow Transplant 50, 523–530 (2015). https://doi.org/10.1038/bmt.2014.297

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