title: Prophylactic use of pegfilgrastim in patients treated with a nitrosourea and teniposide for recurrent glioma.
abstract: OBJECTIVE
  As chemotherapy with teniposide and a nitrosourea is commonly used for the treatment of patients with recurrent glioma but can be associated with severe myelotoxicity, we sought to determine if prophylactic administration of pegfilgrastim could reduce leukopenia or infectious complications in patients receiving this chemotherapeutic regimen.
  
  
  METHODS
  Retrospective medical record review.
  
  
  METHODS
  University-affiliated neurooncology hospital in Frankfurt, Germany.
  
  
  METHODS
  Sixty-four patients who received at least one cycle of a nitrosourea agent (nimustine or lomustine) and teniposide for recurrent glioma between 2008 and 2012; of these patients, 28 did not receive prophylactic pegfilgrastim (cohort A), and 36 patients received prophylactic pegfilgrastim (cohort B).
  
  
  RESULTS
  Blood counts, hospitalizations due to infection or myelosuppression, use of intravenous antibiotics, and survival parameters were analyzed. Leukopenia was more frequently observed before day 30 (early nadir) versus from 30 days until the next cycle (late nadir). In cohort B, Common Terminology Criteria for Adverse Events grade 3 leukopenia in the early nadir occurred less often compared with cohort A (9% in cohort B vs 31% in cohort A). However, the frequency of grade 4 leukopenia, number of days in the hospital due to infection or myelosuppression, days on intravenous antibiotics, progression-free survival, and overall survival were similar between the cohorts.
  
  
  CONCLUSIONS
  Moderate, but not severe, leukopenia or related complications could be prevented by prophylactic pegfilgrastim in patients treated with a nitrosourea and teniposide for recurrent glioma. Our results, therefore, do not support routine prophylactic use of pegfilgrastim in these patients.
authors.affiliation: Dr. Senckenberg Institute of Neurooncology, Goethe University Frankfurt, Frankfurt, Germany.
authors.forename: Anna-Luisa
authors.initials: AL
authors.lastname: Thiepold
authors.forename: Sophie
authors.initials: S
authors.lastname: Lemercier
authors.forename: Kea
authors.initials: K
authors.lastname: Franz
authors.forename: Johannes
authors.initials: J
authors.lastname: Atta
authors.forename: Annette
authors.initials: A
authors.lastname: Sulzbacher
authors.forename: Joachim P
authors.initials: JP
authors.lastname: Steinbach
authors.forename: Johannes
authors.initials: J
authors.lastname: Rieger
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003141:Communicable Diseases / Q000453:epidemiology; D018572:Disease-Free Survival; D005260:Female; D000069585:Filgrastim; D005858:Germany; D005910:Glioma / Q000188:drug therapy*; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D007970:Leukopenia / Q000139:chemically induced / Q000517:prevention & control*; D008130:Lomustine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D015376:Nimustine / Q000008:administration & dosage; D011092:Polyethylene Glycols; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D013713:Teniposide / Q000008:administration & dosage
chemical_list: D011994:Recombinant Proteins; D015376:Nimustine; D016179:Granulocyte Colony-Stimulating Factor; C455861:pegfilgrastim; D011092:Polyethylene Glycols; D008130:Lomustine; D013713:Teniposide; D000069585:Filgrastim
keywords: G-CSF; glioblastoma; leukopenia; nitrosourea; pegfilgrastim; teniposide