title: Neutropenic events in community practices reduced by first and subsequent cycle pegfilgrastim use.
abstract: The impact of first- and subsequent-cycle growth factor use in the community setting has not been studied extensively. We conducted this large, prospective, noncomparative study to assess neutropenia and related complications in patients receiving myelotoxic chemotherapy with pegfilgrastim support in community practices. Patients > or = 18 years old with cancers other than leukemia or myelodysplastic syndrome, including those with major comorbidities, were eligible. Pegfilgrastim (6 mg) was to be administered approximately 24 hours after chemotherapy in all cycles (minimum, four cycles). A total of 2,112 patients was included in the analyses. The most common tumor types were breast cancer (46%), non-Hodgkin's lymphoma (15%), and non-small cell lung cancer (13%). Chemotherapies administered most often were a platinum plus a taxane (18%), and anthracycline plus an alkylating agent (18%), and a taxane plus an anthracycline plus an alkylating agent (16%). The percentage of patients with neutropenia-related hospitalization was 2.9% in cycle 1 and 5.6% across all cycles. Chemotherapy dose reductions and delays were attributed to neutropenia in 1.8% and 0.9% of patients, respectively, in cycle 2 and 2.9% and 2.1% of patients, respectively, across all cycles. Febrile neutropenia (absolute neutrophil count <1.0 x 10(9)/l with temperature > or = 38.2 degrees C) occurred in 3.6% of patients in cycle 1 and in 6.3% of patients across all cycles. The most frequently reported serious adverse events were febrile neutropenia (3.4%), neutropenia (2.6%), and dehydration (2.6%). Bone pain (0.1%) was the only related serious adverse event reported in more than one patient. Data from this community-based study suggest that patients undergoing chemotherapy benefit from pegfilgrastim support beginning in the first cycle of chemotherapy.
authors.affiliation: Section of Hematology-Oncology, University of Oklahoma Health Science Center, PO Box 26901, Williams Pavilion, Room WP2080, Oklahoma City, Oklahoma 73190, USA. howard-ozer@ouhsc.edu
authors.forename: Howard
authors.initials: H
authors.lastname: Ozer
authors.forename: Barry
authors.initials: B
authors.lastname: Mirtsching
authors.forename: Michael
authors.initials: M
authors.lastname: Rader
authors.forename: Susan
authors.initials: S
authors.lastname: Luedke
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Noga
authors.forename: Beiying
authors.initials: B
authors.lastname: Ding
authors.forename: Lyndah
authors.initials: L
authors.lastname: Dreiling
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D003153:Community Health Services; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced / Q000453:epidemiology* / Q000517:prevention & control*; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011994:Recombinant Proteins; D014481:United States / Q000453:epidemiology
chemical_list: D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000069585:Filgrastim