Pegfilgrastim versus filgrastim to accelerate hematopoietic recovery after high-dose melphalan and autologous hematopoietic stem cell transplantation (ASCT) for multiple myeloma

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High-dose melphalan followed by ASCT is a common component of the early treatment for multiple myeloma. Daily subcutaneous injections of filgrastim (Neupogen) at 5 μg/kg/day until ANC> 500/μL are routinely administered at our center from day +4 following ASCT, to accelerate hematopoietic recovery and lessen neutropenic complications. Pegfilgrastim (Neulasta) as a single 6-mg fixed dose via subcutaneous injection has been shown to have similar efficacy and ease of use as filgrastim in the nontransplantation setting, but little data are available in the transplantation setting. We began using pegfilgrastim on day +1 following ASCT for patients with multiple myeloma and performed a retrospective cohort study comparing those who received filgrastim (the filgrastim group[FG]; n= 6) with those who received pegfilgrastim (the pegfilgrastim group[PG]; n= 11). Transplantations occurred between July 2002 and January 2004 and included all patients transplanted for myeloma in that period for whom sufficient data were available. All patients had peripheral stem cells harvested after cytoxan/filgrastim mobilization. Main outcome measures were days from stem cell infusion to WBC nadir, days to ANC> 500/μL, and days to ANC> 1000/μL. Subjects were excluded if CBCs were drawn less often than every 4 days. There were no significant differences between the FG and the PG with respect to the following variables: age, gender, hemoglobin, creatinine, calcium, albumin, beta-2 microglobulin, number of prior lines of therapy, and number of CD34+ cells infused. After transplantation, the median number of days to WBC nadir was 7 (range, 5–9) in the FG and 6 (range, 5–8) in the PG (P= .31). However, median number of days to ANC> 500/μL was 11.5 (range, 11–17) in the FG and 10 (range, 9–12) for the PG (P= .02). Similarly, median number of days to ANC> 1000/μL was 12 (range, 11–17) for the FG and 11 (range, 10–13) for the PG (P= .03). Five of 6 patients in the FG had neutropenic fever after transplantation, compared with 5 of 11 patients in the PG (P= .30). Currently, no significant differences in infection or relapse rates between the groups was noted, and there were no deaths in either group. In this retrospective cohort study, pegfilgrastim was safe and at least equivalent to filgrastim for accelerating hematopoiesis after ASCT for multiple myeloma. Furthermore, there was no significant difference in the incidence of neutropenic fever, infection, and survival, suggesting a similar clinical utility.

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