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Prophylactic Use of Pegfilgrastim in Patients Treated with a Nitrosourea and Teniposide for Recurrent Glioma
Author(s) -
Thiepold AnnaLuisa,
Lemercier Sophie,
Franz Kea,
Atta Johannes,
Sulzbacher Annette,
Steinbach Joachim P.,
Rieger Johannes
Publication year - 2014
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1409
Subject(s) - medicine , pegfilgrastim , leukopenia , teniposide , cohort , lomustine , filgrastim , surgery , chemoimmunotherapy , oncology , glioma , retrospective cohort study , neutropenia , chemotherapy , etoposide , vincristine , cyclophosphamide , cancer research
Study Objective As chemotherapy with teniposide and a nitrosourea is commonly used for the treatment of patients with recurrent glioma but can be associated with severe myelotoxicity, we sought to determine if prophylactic administration of pegfilgrastim could reduce leukopenia or infectious complications in patients receiving this chemotherapeutic regimen. Design Retrospective medical record review. Setting University‐affiliated neurooncology hospital in F rankfurt, G ermany. Patients Sixty‐four patients who received at least one cycle of a nitrosourea agent (nimustine or lomustine) and teniposide for recurrent glioma between 2008 and 2012; of these patients, 28 did not receive prophylactic pegfilgrastim (cohort A ), and 36 patients received prophylactic pegfilgrastim (cohort B ). Measurements and Main Results Blood counts, hospitalizations due to infection or myelosuppression, use of intravenous antibiotics, and survival parameters were analyzed. Leukopenia was more frequently observed before day 30 (early nadir) versus from 30 days until the next cycle (late nadir). In cohort B , C ommon T erminology C riteria for A dverse E vents grade 3 leukopenia in the early nadir occurred less often compared with cohort A (9% in cohort B vs 31% in cohort A ). However, the frequency of grade 4 leukopenia, number of days in the hospital due to infection or myelosuppression, days on intravenous antibiotics, progression‐free survival, and overall survival were similar between the cohorts. Conclusion Moderate, but not severe, leukopenia or related complications could be prevented by prophylactic pegfilgrastim in patients treated with a nitrosourea and teniposide for recurrent glioma. Our results, therefore, do not support routine prophylactic use of pegfilgrastim in these patients.