Pegfilgrastim for prevention of chemotherapy-associated neutropenia in pediatric patients with solid tumors.
BACKGROUND
Pegfilgrastim has similar efficacy to filgrastim in adults, but studies in pediatrics are limited. We report our institutional experience with pegfilgrastim following dose intensive chemotherapy for solid tumors.


METHODS
We evaluated the initial four courses of myelosuppressive chemotherapy for 47 patients (total 176 courses) diagnosed between 1/1/07 and 2/6/08 who received chemotherapy with pegfilgrastim support (100 mcg/kg; 6 mg maximum dose) in this retrospective review. We collected demographic data, treatment characteristics, frequency of severe neutropenia (absolute neutrophil count (ANC) <200/mm(3)), duration of neutropenia, and frequency of neutropenic fever.


RESULTS
The median age of treated patients was 13 years (range 0.17-23 years) and the median weight was 50.8 kg (range 4-107 kg), including 16 (34%) <20 kg, and 22 (47%) <45 kg. Primary diagnoses included osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, soft tissue sarcoma, neuroblastoma, Hodgkin disease, and other solid tumors. No significant adverse events secondary to pegfilgrastim were noted. Severe neutropenia occurred in 57% of courses. The median duration of severe neutropenia was 1 day (range 0-11 days). Febrile neutropenia occurred in 28% of courses. Eight patients were treated with interval-compressed (every 14 days) sarcoma chemotherapy. Of the 30-interval compressed courses, the median duration per course was 14 days (range 14-18 days).


CONCLUSIONS
Pegfilgrastim following dose intensive chemotherapy for solid tumors is feasible in children, including those <45 kg. The frequency and duration of severe neutropenia, as well as incidence of febrile neutropenia, were similar to filgrastim historic data.
Borinstein
Scott C
SC
Fred Hutchinson Cancer Research Center, Seattle, Washington, USA. scott.borinstein@seattlechildrens.org
Pollard
Jessica
J
Winter
Laura
L
Hawkins
Douglas S
DS
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001853:Bone Marrow / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects / Q000627:therapeutic use*; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D009503:Neutropenia / Q000453:epidemiology / Q000517:prevention & control*; D011092:Polyethylene Glycols; D011994:Recombinant Proteins; D012189:Retrospective Studies
D000970:Antineoplastic Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; C455861:pegfilgrastim; D011092:Polyethylene Glycols; D000069585:Filgrastim