Primary Prophylaxis Using Peg-Filgrastim Is Useful Preventing Severe Infections and Neutropenia in Patients Diagnosed with Non Hodgkin Lymphoma (NHL). Report of Latin America International Multicenter Study

Background: Severe infectious events after chemotherapy (CHT) are potentially life-threatening. This is directly related to neutropenia. Granulocyte colony-stimulating factor is used as supporting therapy to prevent neutropenia. Peg-filgrastim has been available in Mexico since 2005 and there is not any report about the use of this drug in Latin America.

Aim: To evaluate grade 4 neutropenia and infections related to neutropenia while using peg-filgrastim.

Methods: Patients between the ages of 18–65, with NHL (de novo or relapsed) with ≤ 30% bone marrow involvement were eligible. CHT was selected by each institution. Complete blood counts were obtained on days 0 (day before chemotherapy), 7, and 14.

Outcomes: Fifty three patients with NHL were included (one withdrew from study after the 2nd cycle of CHT). Three hundred and fourteen cycles were analyzed. Clinical characteristics: Age (mean ±SD): 51.8(±13.5), male: 47%, ECOG ≥ 2:32%), Advance stage (III/IV Ann Arbor): 53%, adjusted IPI (Intermediate/High):60.4%, First-line CHT 72%, second-line CHT 28%. Median neutrophil count (ANM) on day 0 was 8.69 ×10⁹/L (IC_95%: 6.44 to 10.94, previous each CHT), ANM on day +7 was 7.9×10⁹/L (IC_95%: 5.34 a 10.45) and day +14 ANM was 8.61 ×10⁹/L (IC_95%: 6.74 a 10.48) see figure 1. Neutropenia grade 4 was observed in 12.8% of the cycles, being more frequent on day 7 (90%) it means chemotherapy nadir, see figure 2. Severe infectious events were registered in 0.63% of the global cycles (two pneumonias, one of them when ANC was over 2 ×10⁹/L) and non-severe in 1.91% being more frequent superior tract infections. No delays in CHT administration or deaths were reported.

Conclusion: Peg-filgarstim could decrease the frequency of grade 4 neutropenia the day before the next administration of CHT as well as the incidence of severe and non-severe infections in young patients.