Pegfilgrastim Use in Patients with Myeloma Undergoing Autologous Peripheral Blood Stem Cell Transplantation (APBSCT) Is Associated with Early Neutrophil Engraftment and Shorter Inpatient Stay.

Abstract 2275

Poster Board II-252

High dose chemotherapy followed by APBSCT is the current standard of care for myeloma patients younger than 70 years of age with good performance status. Busy haematology centres have severe pressure on bed availability which can limit their ability to deliver multiple cycles of intensive chemotherapy on time. G-CSF use in APBSCT has been shown to hasten neutrophil engraftment and to shorten the number of days of febrile neutropenia. We describe here our experience of the use of a single subcutaneous injection of 6 mg pegfilgrastim on neutrophil engraftment and inpatient stay. This retrospective study included 55 (M: 34; F: 21) patients who had 56 consecutive episodes of APBSCT for myeloma between January 2006 and June 2009. Patients had induction treatment followed by autologous PBSC mobilisation with G-CSF alone or by cyclophosphamide (3g/m²) + G-CSF schedule. Fifty-four patients received first APBSCT (one patient received two APBSCT) with high dose melphalan (200 mg/ m²) conditioning and the day of stem cell re-infusion was termed day 0. Statistical analysis was carried out using GraphPad Prism 4 and SPSS 13 for Windows. Median age at APBSCT was 60 years (range: 42-70). Thirty patients had IgG, 12 IgA, 9 light chain and 4 non secretary myeloma. Prior to transplant 7%, 75% & 18% were in complete, very good partial and partial remission respectively. Twenty-nine per cent of patients received pegfilgrastim on day +1. Some of the remaining patients received varying duration of conventional G-CSF if they had no neutrophil engraftment by day +12. Median CD34+ cell dose/ kg body weight in the pegfilgrastim and the no pegfilgrastim cohort was 3.1 and 2.7 respectively (Mann Whitney test; p value: 0.168). Median duration for neutrophil engraftment in the pegfilgrastim and the no pegfilgrastim cohort was 12 and 14 days respectively (Mann Whitney test; p value: 0.0005). Median duration for platelet engraftment in the pegfilgrastim and the no pegfilgrastim cohort was 21.5 and 16.5 days respectively (Mann Whitney test; p value: 0.253). Median inpatient stay in the pegfilgrastim and the no pegfilgrastim cohort was 16.5 and 18 days respectively (Mann Whitney test; p value: 0.024). There was no difference in the need for intravenous broad spectrum antibiotics (5.5 & 6 median number of days; Mann Whitney test; p value: 0.2514). There was no difference in the overall survival between the two cohorts with a median follow-up of 14 months (range: 1-37). Our data suggests that the use of pegfilgrastim is associated with shorter duration to neutrophil engraftment and reduced inpatient stay. This is very useful considering the severe pressure on the bed availability in the tertiary referral centres. Cost effectiveness due to reduced inpatient stay may lead to the use of pegfilgrastim post autologous stem cell transplantation as a standard practice.