title: Intermittent granulocyte colony-stimulating factor for neutropenia management in patients with relapsed or refractory multiple myeloma treated with lenalidomide plus dexamethasone.
abstract: Neutropenia is a major dose-limiting toxicity associated with lenalidomide in relapsed/refractory multiple myeloma (MM). The optimal dosing schedule of granulocyte colony-stimulating factor (G-CSF) is unclear. We developed an intermittent G-CSF schedule (4-6 doses per cycle) initiated upon onset of grade 3-4 neutropenia. Of 216 patients with relapsed/refractory MM treated at our center with lenalidomide/dexamethasone on an Expanded Access Program, there was a high incidence of grade 3-4 neutropenia (61%) and grade 3-4 infections (37%). Despite intermittent G-CSF use in 117 patients, recurrent grade 3-4 neutropenia was common (59%), and dose reductions were required in 40% of G-CSF recipients, most due to thrombocytopenia. G-CSF recipients had a longer duration on therapy and achieved a higher rate and depth of response. Intermittent G-CSF may be an effective approach for lenalidomide dose-preservation, which may lead to improved outcomes, although it does not prevent infections or thrombocytopenia-related dose limitations.
authors.affiliation: Department of Medicine, University of Toronto , Toronto, ON , Canada.
authors.forename: Haowei Linda
authors.initials: HL
authors.lastname: Sun
authors.forename: Eshetu G
authors.initials: EG
authors.lastname: Atenafu
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Yeboah
authors.forename: Donna E
authors.initials: DE
authors.lastname: Reece
authors.forename: Suzanne
authors.initials: S
authors.lastname: Trudel
authors.forename: Vishal
authors.initials: V
authors.lastname: Kukreti
authors.forename: Esther
authors.initials: E
authors.lastname: Masih-Khan
authors.forename: Andrew
authors.initials: A
authors.lastname: Winter
authors.forename: Christine
authors.initials: C
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D019008:Drug Resistance, Neoplasm; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D053208:Kaplan-Meier Estimate; D000077269:Lenalidomide; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000473:pathology; D009364:Neoplasm Recurrence, Local; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control*; D012189:Retrospective Studies; D013792:Thalidomide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D016179:Granulocyte Colony-Stimulating Factor; D013792:Thalidomide; D003907:Dexamethasone; D000077269:Lenalidomide
keywords: Relapsed or refractory multiple myeloma; granulocyte colony-stimulating factor; infections; lenalidomide plus dexamethasone; neutropenia