title: Incidence of myelodysplastic syndromes in patients receiving concurrent myelosuppressive chemotherapy and pegfilgrastim.
abstract: BACKGROUND
  The World Health Organization classifies myelodysplastic syndromes (MDS) as a group of hematologic malignancies where at least one myeloid lineage contains ≥10% cells with myelodysplasia. Therapy-related MDS (t-MDS) may result from treatment with myelosuppressive chemotherapy and/or radiation. Myeloid growth factors, such as pegfilgrastim, have also been investigated as a possible risk factor for development of t-MDS. National guidelines and myeloid growth factor prescribing information recommend administering myeloid growth factors after a minimum of 24 h following myelosuppressive chemotherapy. Some evidence suggests that administering myeloid growth factors and myelosuppressive chemotherapy concurrently may increase the risk of developing t-MDS.
  
  
  OBJECTIVE
  To evaluate the incidence of t-MDS in patients who received pegfilgrastim and chemotherapy on the same day compared to patients receiving pegfilgrastim at least 1 day following completion of their chemotherapy.
  
  
  METHODS
  A retrospective chart review was performed to identify all patients who received myelosuppressive chemotherapy and pegfilgrastim on the same day between January 2003 and December 2007. Any initial diagnosis of t-MDS was clinically confirmed.
  
  
  RESULTS
  A total of 227 patients received myelosuppressive chemotherapy and pegfilgrastim on the same day. Median time to follow-up was 3.47 years (IQR 1.15). Two patients had a confirmed diagnosis of t-MDS. The incidence of t-MDS in patients receiving concurrent myelosuppressive chemotherapy and pegfilgrastim in our study population is 0.88%.
  
  
  CONCLUSIONS
  Administering pegfilgrastim at least 1 day after myelosuppressive chemotherapy may help reduce the risk of t-MDS, but more studies with longer follow-up are needed to confirm this finding.
authors.affiliation: Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Covert
authors.forename: Jose R
authors.initials: JR
authors.lastname: Murillo
authors.forename: James E
authors.initials: JE
authors.lastname: Cox
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D000069585:Filgrastim; D005500:Follow-Up Studies; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000139:chemically induced / Q000188:drug therapy* / Q000453:epidemiology*; D011092:Polyethylene Glycols; D011994:Recombinant Proteins / Q000008:administration & dosage; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; C455861:pegfilgrastim; D011092:Polyethylene Glycols; D000069585:Filgrastim