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Pegfilgrastim as hematopoietic support for dose-dense chemoimmunotherapy with R-CHOP-14 as first-line therapy in elderly patients with diffuse large B cell lymphoma

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Abstract

Goals of work

Recently, 6 cycles of R-CHOP-14 have been recommended as the reference standard regimen for the treatment of elderly patients with diffuse large B-cell lymphoma (DLBCL). Pegfilgrastim has been shown to facilitate dose-dense chemotherapy schedules with a single administration per chemotherapy cycle. The aims of this study were to evaluate the use of pegfilgrastim in combination with the R-CHOP-14 regimen in a homogenous group of previously untreated elderly patients with DLBCL and to assess the pharmacokinetics of pegfilgrastim within this patient population.

Materials and methods

Ten patients with DLBCL between 60 and 80 years of age received a single subcutaneous injection of 6 mg pegfilgrastim 24 h after administration of R-CHOP chemoimmunotherapy, which was repeated for 6 to 8 cycles in two-weekly intervals. A total of 348 blood samples were collected. Pegfilgrastim plasma levels and absolute neutrophil counts were measured every other day during the first treatment cycle and twice weekly during all consecutive cycles.

Main results

Sixty-three of 72 cycles (87.5%) could be delivered on time and at the planned dose. Median absolute neutrophil nadir was 0.32 g/l on day 9. Grade 3/4 granulocytopenia occurred in all patients. Febrile neutropenia occurred in two patients. Plasma levels of pegfilgrastim remained elevated during the neutropenic phase. At the start of hematologic recovery, plasma concentrations of pegfilgrastim decreased rapidly to baseline levels. Median pegfilgrastim trough plasma level was 0.43 ng/ml on the day preceding the next application.

Conclusions

A single fixed dose of 6 mg of pegfilgrastim given once per cycle of R-CHOP-14 is effective in supporting neutrophil recovery to allow two-weekly drug administration in previously untreated elderly patients with DLBCL. However, close monitoring for infectious complications is mandatory in this patient population.

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Acknowledgments

Our special thanks go to the employees of the hematology laboratory of the Department of Internal Medicine I, University of Bonn, Mrs. Lange, Mrs. Schenkel, and Mrs. Leufgens, for their exemplary assistance and support with regard to blood sample collection. Likewise, we also thank the employees of CellTrend GmbH, Luckenwalde, for their accurate and prompt work on pegfilgrastim plasma level measurements. Finally, we want to thank Dr. T. Sauerbruch, Bonn, and Stefanie Baumgartner, Zurich, Switzerland, for carefully reading the manuscript.

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Authors and Affiliations

  1. Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany

    Ulrich J. M. Mey, Anna Maier, Ingo G. H. Schmidt-Wolf, John W. Strehl & Marcus Gorschlueter

  2. Hematology/Oncology Group Practice, Troisdorf, Germany

    Carsten Ziske & Helmut Forstbauer

  3. Department of Hematology and Oncology, University of Giessen and Marburg, Campus Giessen, Giessen, Germany

    Gamal-Andre Banat

  4. Department of Clinical Pharmacology, University of Bonn, Bonn, Germany

    Gamal-Andre Banat & Michael Reber

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  1. Ulrich J. M. Mey
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Correspondence to Ulrich J. M. Mey.

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Mey, U.J.M., Maier, A., Schmidt-Wolf, I.G.H. et al. Pegfilgrastim as hematopoietic support for dose-dense chemoimmunotherapy with R-CHOP-14 as first-line therapy in elderly patients with diffuse large B cell lymphoma. Support Care Cancer 15, 877–884 (2007). https://doi.org/10.1007/s00520-006-0201-z

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  • DOI: https://doi.org/10.1007/s00520-006-0201-z

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