Background: While recommended timing of pegfilgrastim administration is ≥24 h after chemotherapy, patient barriers to next day administration, available adult evidence, and pharmacokinetic data have led to earlier administration in some pediatric patients with solid and central nervous system tumors. The purpose of this study was to compare patient outcomes by timing of pegfilgrastim after chemotherapy. Methods: A retrospective chart review examined timing of 932 pegfilgrastim administrations to 182 patients, 0–29 years of age. The primary outcome was febrile neutropenia (FN); the secondary outcome was neutropenic delays (ND) ≥7 days to next chemotherapy cycle. To account for multiple pegfilgrastim administrations per patient, a generalized mixed model was used with a logit link for the dichotomous outcomes (FN & ND), timing as the dichotomous independent variable, and random effect for patient. Results: FN occurred in 196 of 916 cycles (21.4%); and ND in 19 of 805 cycles (2.4%). The fixed effect of pegfilgrastim administration < or ≥24 h after chemotherapy was not significant, p = .50; however, earlier or later than 20 h was significant, p = .005. FN odds were significantly higher when pegfilgrastim was given <20 h (OR 1.78, 95% CI: 1.19–2.65) after chemotherapy, which may be attributable to differences in chemotherapy toxicity regardless of pegfilgrastim timing. Discussion: While attempts should be made to administer pegfilgrastim ≥24 h after chemotherapy, if barriers exist, modified timing based on individual patient characteristics should be considered. Prospective randomized trials are needed to identify lower risk patients for early pegfilgrastim administration.

背景：虽然推荐的 pegfilgrastim 给药时间为化疗后≥24 小时，但患者第二天给药的障碍、可用的成人证据和药代动力学数据导致在一些患有实体和中枢神经系统肿瘤的儿科患者中更早给药。本研究的目的是通过化疗后聚乙二醇非格司亭的时间比较患者结果。方法：一项回顾性图表审查检查了 182 名 0-29 岁患者的 932 次聚乙二醇非格司亭给药时间。主要结果是发热性中性粒细胞减少症 (FN)；次要结果是中性粒细胞减少延迟 (ND) ≥ 7 天到下一个化疗周期。为说明每位患者多次给予聚乙二醇非格司亭，使用广义混合模型，对二分结果 (FN & ND)、时间作为二分自变量和患者随机效应的 logit 链接。结果： FN 发生在 916 个周期中的 196 个（21.4%）；和 ND 在 805 个循环中的 19 个 (2.4%)。pegfilgrastim 给药 < 或 ≥ 化疗后 24 h 的固定效应不显着，p  = .50；然而，早于或晚于 20 h 是显着的，p = .005。当化疗后给予培非格司亭 <20 小时（OR 1.78，95% CI：1.19-2.65）时，FN 几率显着更高，这可能归因于化疗毒性的差异，而不管培非格司亭时间如何。讨论：虽然应尝试在化疗后 24 小时以上使用聚乙二醇非格司亭，但如果存在障碍，应考虑根据患者个体特征调整时间。需要前瞻性随机试验来确定早期使用聚乙二醇非格司亭的风险较低的患者。