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A comparative effectiveness study of lipegfilgrastim in multiple myeloma patients after high dose melphalan and autologous stem cell transplant

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Abstract

G-CSF administration after high-dose chemotherapy and autologous stem cell transplantation (ASCT) has been shown to expedite neutrophil recovery. Several studies comparing filgrastim and pegfilgrastim in the post-ASCT setting concluded that the two are at least equally effective. Lipegfilgrastim (LIP) is a new long-acting, once-per-cycle G-CSF. This multicentric, prospective study aimed to describe the use of LIP in multiple myeloma patients receiving high-dose melphalan and autologous stem cell transplantation (ASCT) and compare LIP with historic controls of patients who received short-acting agent (filgrastim [FIL]). Overall, 125 patients with a median age of 60 years received G-CSF after ASCT (80 patients LIP on day 1 post-ASCT and 45 patients FIL on day 5 post-ASCT). The median duration of grade 4 neutropenia (absolute neutrophil count [ANC] < 0.5 × 10 [9]/L) was 5 days in both LIP and FIL groups, whereas the median number of days to reach ANC ≥ 0.5 × 10 [9]/L was 10% lower in the LIP than in the FIL group (10 vs 11 days), respectively. Male sex was significantly associated with a faster ANC ≥ 0.5 × 10 [9] L response (p = 0.015). The incidence of FN was significantly lower in the LIP than in the FIL group (29% vs 49%, respectively, p = 0.024). The days to discharge after ASCT infusion were greater in patients with FN (p < 0.001). The study indicates that LIP had a shorter time to ANC recovery and is more effective than FIL for the prevention of FN in the ASCT setting.

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Authors and Affiliations

  1. Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy

    Massimo Martino, Pasquale Fabio Provenzano, Virginia Naso, Anna Ferreri, Tiziana Moscato, Giuseppe Console, Barbara Loteta & Giuseppe Alberto Gallo

  2. CNR-IFC, Rome, Italy

    Mercedes Gori & Annalisa Pitino

  3. CNR-IFC, Research Unit of Reggio Calabria, Reggio Calabria, Italy

    Giovanni Tripepi

  4. Department of Hematology, Unità di Ricerca Biotecnologica, Cosenza, Italy

    Anna Grazia Recchia

  5. Hematology Unit, Azienda Ospedaliera Regionale S. Carlo - Ospedale San Carlo, Potenza, Italy

    Michele Cimminiello

  6. Hematology Unit, Department of Hemato-Oncology, Ospedale Annunziata, Cosenza, Italy

    Massimo Gentile

  7. Division of Hematology, Department of Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Messina, Italy

    Vanessa Innao

  8. Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy

    Marco Rossi

  9. Pharmacy Unit, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy

    Antonella Morabito

  10. Hematology Unit, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy

    Iolanda Donatella Vincelli

  11. Hematology Unit, Azienda Ospedaliera, Papardo, Messina, Italy

    Donato Mannina

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  1. Massimo Martino
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  2. Mercedes Gori
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  3. Giovanni Tripepi
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  17. Iolanda Donatella Vincelli
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  18. Donato Mannina
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  19. Annalisa Pitino
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Corresponding authors

Correspondence to Massimo Martino or Mercedes Gori.

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The study was approved by the local institutional review board and was conducted according to the Declaration of Helsinki and the International Conference on Harmonization Guidelines for Good Clinical Practice. All patients provided written informed consent before inclusion.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Martino, M., Gori, M., Tripepi, G. et al. A comparative effectiveness study of lipegfilgrastim in multiple myeloma patients after high dose melphalan and autologous stem cell transplant. Ann Hematol 99, 331–341 (2020). https://doi.org/10.1007/s00277-019-03901-w

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