Comparison of filgrastim, pegfilgrastim, and lipegfilgrastim added to chemotherapy for mobilization of CD34 cells in non-Hodgkin lymphoma patients.

BACKGROUND

Data are limited on the long-acting granulocyte-colony stimulating factors (G-CSFs) pegfilgrastim (PEG) and lipegfilgrastim (LIPEG) compared with filgrastim (FIL) regarding the mobilization efficiency of CD34 cells, graft cellular composition, and engraftment.

STUDY DESIGN AND METHODS

In this prospective nonrandomized study, 36 patients with non-Hodgkin lymphoma received FIL, 67 received PEG, and 16 patients received LIPEG as a cytokine after chemotherapy. We analyzed the mobilization and collection of CD34 cells, cellular composition of blood grafts, and hematologic recovery after auto-SCT according to the type of G-CSF used.

RESULTS

Patients in the LIPEG group had fewer apheresis sessions (1 vs. 2, p = 0.021 for FIL and p = 0.111 for PEG) as well as higher median blood CD34 cell counts at the start of the first apheresis (LIPEG 74 × 10 /L vs. FIL 31 × 10 /L, p = 0.084 or PEG 27 × 10 /L, p = 0.021) and CD34 yields of the first apheresis (FIL 5.1 × 10 /kg vs. FIL 2.3 × 10 /kg, p = 0.105 or PEG 1.8 × 10 /kg, p = 0.012). Also, the costs associated with G-CSF mobilization and apheresis were lower in the LIPEG group. The graft composition was comparable except for the higher infused CD34 cell counts in the LIPEG group. The engraftment kinetics were significantly slower in the FIL group.

CONCLUSION

LIPEG appears to be more efficient compared with PEG after chemotherapy to mobilize CD34 cells for auto-SCT demonstrated as fewer sessions of aphereses needed as well as 2.8-fold CD34 cell yields on the first apheresis day. Early hematologic recovery was more rapid in the LIPEG group. Thus further studies on LIPEG in the mobilization setting are warranted.