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Yoshinami T, Nozawa K, Yokoe T, Ozaki Y, Nishio H, Tsuchihashi K, Ichihara E, Miura Y, Endo M, Yano S, Maruyama D, Susumu N, Takekuma M, Motohashi T, Ito M, Baba E, Ochi N, Kubo T, Uchino K, Kimura T, Kamiyama Y, Nakao S, Tamura S, Nishimoto H, Kato Y, Sato A, Takano T. Comparison between a single dose of PEG G-CSF and multiple doses of non-PEG G-CSF: a systematic review and meta-analysis from Clinical Practice Guidelines for the use of G-CSF 2022. Int J Clin Oncol 2024; 29:681-688. [PMID: 38649648 DOI: 10.1007/s10147-024-02504-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/04/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUD Granulocyte colony-stimulating factor (G-CSF) is widely used for the primary prophylaxis of febrile neutropenia (FN). Two types of G-CSF are available in Japan, namely G-CSF chemically bound to polyethylene glycol (PEG G-CSF), which provides long-lasting effects with a single dose, and non-polyethylene glycol-bound G-CSF (non-PEG G-CSF), which must be sequentially administrated for several days. METHODS This current study investigated the utility of these treatments for the primary prophylaxis of FN through a systematic review of the literature. A detailed literature search for related studies was performed using PubMed, Ichushi-Web, and the Cochrane Library. Data were independently extracted and assessed by two reviewers. A qualitative analysis or meta-analysis was conducted to evaluate six outcomes. RESULTS Through the first and second screenings, 23 and 18 articles were extracted for qualitative synthesis and meta-analysis, respectively. The incidence of FN was significantly lower in the PEG G-CSF group than in the non-PEG G-CSF group with a strong quality/certainty of evidence. The differences in other outcomes, such as overall survival, infection-related mortality, the duration of neutropenia (less than 500/μL), quality of life, and pain, were not apparent. CONCLUSIONS A single dose of PEG G-CSF is strongly recommended over multiple-dose non-PEG G-CSF therapy for the primary prophylaxis of FN.
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Affiliation(s)
- Tetsuhiro Yoshinami
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
| | - Kazuki Nozawa
- Department of Center for Cancer Genomics and Advanced Therapeutics, Breast Oncology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Takamichi Yokoe
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yukinori Ozaki
- Department of Breast Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroshi Nishio
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kenji Tsuchihashi
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University, Fukuoka, Japan
| | - Eiki Ichihara
- Center for Clinical Oncology, Okayama University Hospital, Okayama, Japan
| | - Yuji Miura
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Makoto Endo
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Shingo Yano
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Dai Maruyama
- Department of Hematology Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Nobuyuki Susumu
- Department of Obstetrics and Gynecology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | | | - Takashi Motohashi
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Mamoru Ito
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University, Fukuoka, Japan
| | - Eishi Baba
- Department of Oncology and Social Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuaki Ochi
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Toshio Kubo
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Keita Uchino
- Department of Medical Oncology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yutaro Kamiyama
- Department of Clinical Oncology/Hematology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinji Nakao
- Department of Hematology, Faculty of Medicine, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Shinobu Tamura
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - Hitomi Nishimoto
- Department of Nursing, Okayama University Hospital, Okayama, Japan
| | - Yasuhisa Kato
- Department of Drug Information, Faculty of Pharmaceutical Sciences, Shonan University of Medical Sciences, Kanagawa, Japan
| | - Atsushi Sato
- Department of Medical Oncology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Toshimi Takano
- Department of Breast Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Yingling SK, Francis J, Seago K, Safi SUD, Wen S, Cumpston A. Efficacy of delayed pegfilgrastim administration following consolidation therapy with high-dose cytarabine (HiDAC) in acute myeloid leukemia (AML) patients. Support Care Cancer 2024; 32:276. [PMID: 38589646 DOI: 10.1007/s00520-024-08480-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE To study the effects of delaying pegfilgrastim administration following high-dose cytarabine (HiDAC) consolidation in AML patients on time to neutrophil count recovery, infectious complications, and survival. METHODS Single-center retrospective chart review of 55 patients receiving pegfilgrastim as early administration (within 72 h) or delayed administration (after 72 h) of HiDAC. RESULTS The difference in neutrophil recovery time was similar between the early and delayed groups (18 days versus 19 days, p < 0.28). Infections were seen in four patients in the early administration group following chemotherapy compared to none in the delayed group (p = 0.04). Febrile neutropenia rates were also decreased in the delayed administration group (23.1% versus 10.3%, p = 0.28) as well as a trend towards longer median survival (16 months versus 19 months, p = 0.69) and overall survival (21 months versus 31 months, p = 0.47). CONCLUSION A difference in time to neutrophil recovery was not observed between the early and delayed administration groups yet decreased infectious complications may support the delayed administration of pegfilgrastim in these patients.
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Affiliation(s)
- Spencer K Yingling
- Department of Pharmacy, West Virginia University Hospital, Morgantown, WV, USA.
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, WV, USA.
| | - Joshua Francis
- Department of Pharmacy, West Virginia University Hospital, Morgantown, WV, USA
| | - Kelsea Seago
- Department of Pharmacy, West Virginia University Hospital, Morgantown, WV, USA
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, WV, USA
| | - Salah Ud Din Safi
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, WV, USA
| | - Sijin Wen
- Department of Biostatistics, West Virginia University, Morgantown, WV, USA
| | - Aaron Cumpston
- Department of Pharmacy, West Virginia University Hospital, Morgantown, WV, USA
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, WV, USA
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Reimann AM, Schalk E, Jost F, Mougiakakos D, Weber D, Döhner H, Récher C, Dumas PY, Ditzhaus M, Fischer T, Sager S. AML consolidation therapy: timing matters. J Cancer Res Clin Oncol 2023; 149:13811-13821. [PMID: 37535164 PMCID: PMC10590325 DOI: 10.1007/s00432-023-05115-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/04/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE Infections due to severe neutropenia are the most common therapy-associated causes of mortality in patients with acute myeloid leukemia (AML). New strategies to lessen the severity and duration of neutropenia are needed. METHODS Cytarabine is commonly used for AML consolidation therapy; we compared high- and intermediate-dose cytarabine administration on days 1, 2, and 3 (AC-123) versus days 1, 3, and 5 (AC-135) in consolidation therapy of AML. Recently, clinical trials demonstrated that high-dose AC-123 resulted in a shortened white blood cell (WBC) recovery time compared with high-dose AC-135. Our main hypothesis is that this is also the case for different cytarabine dosage, granulocyte colony-stimulating factor (G-CSF) administration, and cycle lengths. We analyzed 334 treatment schedules on virtual cohorts of digital twins. RESULTS Comparison of 32,565 simulated consolidation cycles resulted in a reduction in the WBC recovery time for AC-123 in 99.6% of the considered cycles (median reduction 3.5 days) without an increase in the number of leukemic blasts (lower value in 94.2% of all cycles), compared to AC-135. CONCLUSION Our numerical study supports the use of AC-123 plus G-CSF as standard conventional AML consolidation therapy to reduce the risk for life-threatening infectious complications.
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Affiliation(s)
| | - Enrico Schalk
- Clinics of Hematology and Oncology, Otto von Guericke University (OVGU), Magdeburg, Germany
| | - Felix Jost
- Department of Mathematics, Otto von Guericke University (OVGU), Magdeburg, Germany
- R&D, Sanofi-Aventis Deutschland GmbH, Frankfurt, Germany
| | - Dimitrios Mougiakakos
- Clinics of Hematology and Oncology, Otto von Guericke University (OVGU), Magdeburg, Germany
| | - Daniela Weber
- Department of Internal Medicine III, University Hospital, Ulm, Germany
| | - Hartmut Döhner
- Department of Internal Medicine III, University Hospital, Ulm, Germany
| | - Christian Récher
- Service d'Hématologie, Institut Universitaire du Cancer de Toulouse Oncopole, Centre Hospitalier Universitaire, Toulouse, France
| | - Pierre-Yves Dumas
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Marc Ditzhaus
- Department of Mathematics, Otto von Guericke University (OVGU), Magdeburg, Germany
| | - Thomas Fischer
- Clinics of Hematology and Oncology, Otto von Guericke University (OVGU), Magdeburg, Germany
| | - Sebastian Sager
- Department of Mathematics, Otto von Guericke University (OVGU), Magdeburg, Germany.
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Rastogi S, Kalaiselvan V, Ali S, Ahmad A, Guru SA, Sarwat M. Efficacy and Safety of Filgrastim and Its Biosimilars to Prevent Febrile Neutropenia in Cancer Patients: A Prospective Study and Meta-Analysis. BIOLOGY 2021; 10:biology10101069. [PMID: 34681169 PMCID: PMC8533340 DOI: 10.3390/biology10101069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/07/2021] [Accepted: 10/14/2021] [Indexed: 01/08/2023]
Abstract
Simple Summary Febrile neutropenia is the serious side-effect associated with myelosuppressive chemotherapy. Filgrastim, the first granulocyte colony-stimulating factor (G-CSF) was approved by the Food and Drug Administration for the treatment of neutropenia. Subsequently, pegfilgrastim (long-acting G-CSF) and filgrastim biosimilars were developed to have comparable efficacy to filgrastim. Therefore, it is necessary to produce a systematic review and meta-analysis that provides evidence that filgrastim is more efficacious than placebo/no-treatment, as it provides evidence on the comparable efficacy of filgrastim versus pegfilgrastim and biosimilar filgrastim. Abstract Background: The aim of this review and meta-analysis was to identify, assess, meta-analyze and summarize the comparative effectiveness and safety of filgrastim in head-to-head trials with placebo/no treatment, pegfilgrastim (and biosimilar filgrastim to update advances in the field. Methods: The preferred reporting items for systematic reviews and meta-analyses PRISMA statement were applied, and a random-effect model was used. Primary endpoints were the rate and duration of grade 3 or 4 neutropenia, and an incidence rate of febrile neutropenia. Secondary endpoints were time to absolute neutrophil count ANC recovery, depth of ANC nadir (lowest ANC), neutropenia-related hospitalization and other neutropenia-related complications. For filgrastim versus biosimilar filgrastim comparison, the primary efficacy endpoint was the mean difference in duration of severe neutropenia DSN. Results: A total of 56 studies were considered that included data from 13,058 cancer patients. The risk of febrile neutropenia in filgrastim versus placebo/no treatment was not statistically different. The risk ratio for febrile neutropenia was 0.58, a 42% reduction in favor of filgrastim. The most reported adverse event with FIL was bone pain. For pegfilgrastim versus filgrastim, no statistically significant difference was noted. The risk ratio was 0.90 (95% CI 0.67 to 1.12). The overall difference in duration of severe neutropenia between filgrastim and biosimilar filgrastim was not statistically significant. The risk ratio was 1.03 (95% CI 0.93 to 1.13). Conclusions: Filgrastim was effective and safe in reducing febrile neutropenia and related complications, compared to placebo/no treatment. No notable differences were found between pegfilgrastim and filgrastim in terms of efficacy and safety. However, a similar efficacy profile was observed with FIL and its biosimilars.
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Affiliation(s)
- Shruti Rastogi
- Indian Pharmacopoeia Commission, Ministry of Health & Family Welfare, Government of India, Sector-23, Raj Nagar, Ghaziabad 201002, Uttar Pradesh, India; (S.R.); (V.K.)
- Amity Institute of Pharmacy, Amity University, Noida 201301, Uttar Pradesh, India
| | - Vivekananda Kalaiselvan
- Indian Pharmacopoeia Commission, Ministry of Health & Family Welfare, Government of India, Sector-23, Raj Nagar, Ghaziabad 201002, Uttar Pradesh, India; (S.R.); (V.K.)
| | - Sher Ali
- School of Basic Sciences and Research, Department of Life Sciences, Sharda University, Greater Noida 201310, Uttar Pradesh, India;
| | - Ajaz Ahmad
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Sameer Ahmad Guru
- Lurie Children’s Hospital, Department of Pediatric Surgery, Northwestern University, Chicago, IL 60611, USA;
| | - Maryam Sarwat
- Amity Institute of Pharmacy, Amity University, Noida 201301, Uttar Pradesh, India
- Correspondence: or
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Li W, Richter K, Lee J, McCarthy K, Kubal T. Safety and feasibility of outpatient high-dose cytarabine and intermediate-dose cytarabine for consolidation therapy in acute myeloid leukemia. J Oncol Pharm Pract 2021; 28:1812-1818. [PMID: 34609924 DOI: 10.1177/10781552211046574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The standard of care consolidation therapy for acute myeloid leukemia is high-dose cytarabine or intermediate-dose cytarabine, which are traditionally given inpatient. At Moffitt Cancer Center, we have moved the administration of high-dose cytarabine and intermediate-dose cytarabine to the outpatient setting through the inpatient/outpatient program. To facilitate outpatient administration, high-dose cytarabine and intermediate-dose cytarabine are given in a shorter interval of every 10 h instead of 12 h. The safety of a shorter duration interval of high-dose cytarabine and intermediate-dose cytarabine is unknown. This study aims to assess the safety and feasibility of administering high-dose cytarabine and intermediate-dose cytarabine consolidation therapy in the inpatient/outpatient setting. METHODS This is a retrospective chart review to analyze acute myeloid leukemia patients treated with inpatient/outpatient high-dose cytarabine or intermediate-dose cytarabine consolidation therapy at Moffitt Cancer Center from January 1, 2015, through November 1, 2018. The primary objective was to determine the incidence of hospitalization during the inpatient/outpatient administration of high-dose cytarabine or intermediate-dose cytarabine. RESULTS Two hundred fifty-three of 255 cycles of high-dose cytarabine/intermediate-dose cytarabine were delivered outpatient over the reviewed time period to 118 patients. No patients receiving outpatient high-dose cytarabine/intermediate-dose cytarabine consolidation required hospitalization during chemotherapy. Our incidence of hospitalization (24%) after chemotherapy is consistent with the reported literature. Through the inpatient/outpatient administration of high-dose cytarabine and intermediate-dose cytarabine, 1265 inpatient days were saved with an approximate revenue of $3,135,176 generated in our study period. CONCLUSION Inpatient/outpatient administration of high-dose cytarabine and intermediate-dose cytarabine is both safe and feasible. Moving high-dose cytarabine/intermediate-dose cytarabine administration to the outpatient setting resulted in significant additional revenue vs. inpatient administration.
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Affiliation(s)
- Wenhui Li
- 158424University of Miami Hospital and Clinics, Miami, FL, USA
| | | | - Jamie Lee
- 25301H. Lee Moffitt Cancer Center, Tampa, FL, USA
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Delivering HDAC over 3 or 5 days as consolidation in AML impacts health care resource consumption but not outcome. Blood Adv 2021; 4:3840-3849. [PMID: 32790847 DOI: 10.1182/bloodadvances.2020002511] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/14/2020] [Indexed: 11/20/2022] Open
Abstract
Postremission treatment is crucial to prevent relapse in acute myeloid leukemia (AML). High-dose cytarabine delivered every 12 hours on days 1, 3, and 5 (HDAC-135) is the standard of care for younger adult patients with AML. Although this standard has been unsuccessfully challenged by other treatment regimens, including multiagent chemotherapy, the timing of HDAC administration has attracted little attention. Here, we retrospectively compared the safety, efficacy, and health care resource consumption associated with HDAC-135 and another standard, condensed HDAC-123 regimen, as consolidation treatment in younger AML patients in first complete response. This study included 221 patients (median age, 46.6 years; range, 18-60 years). HDAC-123 and HDAC-135 were used in 92 and 129 patients, respectively. Both regimens were associated with similar rates of relapse-free survival, cumulative incidence of relapse, nonrelapse mortality, and overall survival, including in core binding factor AML subgroup in which levels of minimal residual disease reduction were similar in both schedules. Hematological recovery times regarding neutrophils and platelets were significantly shorter in patients receiving HDAC-123, with an average difference of 3 to 4 days for each consolidation cycle. The total duration of hospitalization for the whole postremission program was shorter with HDAC-123 (32 days; interquartile ratio [IQR], 22.0,36.5) compared with HDAC-135 (41 days; IQR, 30.5, 50.0) (P < .0001). In conclusion, the condensed HDAC-123 regimen induced faster hematological recovery and therefore significantly reduced the length of hospital stay without affecting treatment response or outcome in younger AML patients.
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Esfandbod M, Agha Bararzadeh F, Faraz M, Zarrabi F, Toogeh G. Comparison of Long-Acting G-CSF (PD-Lasta) with Short-Acting G-CSF (PD-Grastim) in Neutrophil Recovery Following Consolidation Chemotherapy with High-Dose Cytarabine in Acute Myeloid Leukemia: A Randomized Clinical Trial. Int J Hematol Oncol Stem Cell Res 2021; 15:96-102. [PMID: 34466208 PMCID: PMC8381103 DOI: 10.18502/ijhoscr.v15i2.6040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 06/01/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Acute myeloid leukemia (AML) patients are often neutropenic as a result of their disease alone or following their chemotherapy. In this randomized clinical trial the efficacy of Iranian short-acting (PD-Grastim) and long-acting G-CSF (PD-Lasta) were compared in term of time to recovery from neutropenia in de novo AML patients following the consolidation chemotherapy. Materials andMethods: Patients (n = 51) received one or two courses of Cytarabine and Daunorubicin as an induction. If complete remission was achieved, the treatment was followed by high-dose Cytarabine as consolidation chemotherapy. Twenty- four hours after the consolidation chemotherapy, patient were randomized to receive either daily short-acting G-CSF (PD-Grastim) (300 µg/kg) or single-dose long-acting G-CSF (PD-Lasta) (6 mg). Results: The median time to recovery of neutrophils was 11.00 and 13.00 days for short-acting G-CSF (PD-Grastim) (n=22) and long-acting G-CSF (PD-Lasta) (n=29) groups, respectively (U=186.5, P>0.05 two-tailed). Incidence of adverse effects was similar in both short-acting G-CSF (PD-Grastim) and long-acting G-CSF (PD-Lasta) groups. Conclusion: Overall, data show that Iranian long-acting G-CSF (PD-Lasta) was not significantly different with Iranian short-acting G-CSF (PD-Grastim).
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Affiliation(s)
- Mohsen Esfandbod
- Thrombosis Hemostasis Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mona Faraz
- Thrombosis Hemostasis Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Zarrabi
- Thrombosis Hemostasis Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Toogeh
- Thrombosis Hemostasis Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Leaman R, Wei CH, Allot A, Lu Z. Ten tips for a text-mining-ready article: How to improve automated discoverability and interpretability. PLoS Biol 2020; 18:e3000716. [PMID: 32479517 PMCID: PMC7289435 DOI: 10.1371/journal.pbio.3000716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/11/2020] [Indexed: 12/22/2022] Open
Abstract
Data-driven research in biomedical science requires structured, computable data. Increasingly, these data are created with support from automated text mining. Text-mining tools have rapidly matured: although not perfect, they now frequently provide outstanding results. We describe 10 straightforward writing tips—and a web tool, PubReCheck—guiding authors to help address the most common cases that remain difficult for text-mining tools. We anticipate these guides will help authors’ work be found more readily and used more widely, ultimately increasing the impact of their work and the overall benefit to both authors and readers. PubReCheck is available at http://www.ncbi.nlm.nih.gov/research/pubrecheck. Your published research is already being processed with automated tools, and text mining will become more common; this Community Page article describes how you can help these tools process your work more accurately, including a web tool, PubReCheck.
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Affiliation(s)
- Robert Leaman
- National Center for Biotechnology Information (NCBI), National Library of Medicine (NLM), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Chih-Hsuan Wei
- National Center for Biotechnology Information (NCBI), National Library of Medicine (NLM), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Alexis Allot
- National Center for Biotechnology Information (NCBI), National Library of Medicine (NLM), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Zhiyong Lu
- National Center for Biotechnology Information (NCBI), National Library of Medicine (NLM), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
- * E-mail:
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Kitagawa Y, Osumi H, Shinozaki E, Ota Y, Nakayama I, Suzuki T, Wakatsuki T, Ogura M, Ooki A, Takahari D, Suenaga M, Chin K, Yamaguchi K. Clinical utility of polyethylene glycol conjugated granulocyte colony-stimulating factor (PEG-G-CSF) for preventing severe neutropenia in metastatic colorectal cancer patients treated with FOLFOXIRI plus bevacizumab: a single-center retrospective study. BMC Cancer 2020; 20:358. [PMID: 32345249 PMCID: PMC7189469 DOI: 10.1186/s12885-020-06864-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 04/14/2020] [Indexed: 12/22/2022] Open
Abstract
Background This study aimed to evaluate the efficacy and the safety of polyethylene glycol conjugated granulocyte colony-stimulating factor (PEG-G-CSF) for preventing neutropenia in metastatic colorectal cancer (mCRC) patients that received fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) plus bevacizumab (Bev) in clinical practice. Methods We retrospectively analyzed mCRC patients who received FOLFOXIRI plus Bev between December 2015 and December 2017. We evaluated the efficacy of PEG-G-CSF as preventing or treating grade 3 or 4 neutropenia, the overall response rate (ORR) according to the Response Evaluation Criteria in Solid Tumors version 1.1, progression-free survival (PFS), overall survival (OS), and adverse events of FOLFOXIRI plus Bev based on the Common Terminology Criteria for Adverse Events version 4.0. Results A total of 26 patients (median age 53.5 years) were included. The ORR rate was 65.3%, the median PFS was 9.6 months (7.2–16.9), and the median OS was 24.2 months (13.6–NA). Grade 3 or 4 neutropenia occurred in 53.8% of the patients, and febrile neutropenia occurred in 7.7%. PEG-G-CSF was given to 77.0% of the patients, including prophylactically (n = 9) and after the development of grade 3 or 4 neutropenia (n = 11). No patients experienced grade 3 or 4 neutropenia after the administration of PEG-G-CSF. In seven of the nine patients who received PEG-G-CSF prophylactically (77.8%), no dose adjustment was required. Conclusions PEG-G-CSF is useful in preventing severe neutropenia in mCRC patients treated with FOLFOXIRI plus Bev.
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Affiliation(s)
- Yusuke Kitagawa
- Department of Gastroenterology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Hiroki Osumi
- Department of Gastroenterology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Eiji Shinozaki
- Department of Gastroenterology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Yumiko Ota
- Department of Gastroenterology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Izuma Nakayama
- Department of Gastroenterology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takeshi Suzuki
- Department of Gastroenterology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takeru Wakatsuki
- Department of Gastroenterology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Mariko Ogura
- Department of Gastroenterology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Akira Ooki
- Department of Gastroenterology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Daisuke Takahari
- Department of Gastroenterology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Mitsukuni Suenaga
- Department of Gastroenterology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Keisho Chin
- Department of Gastroenterology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Kensei Yamaguchi
- Department of Gastroenterology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Efficacy and tolerability of granulocyte colony-stimulating factors in cancer patients after chemotherapy: A systematic review and Bayesian network meta-analysis. Sci Rep 2019; 9:15374. [PMID: 31653961 PMCID: PMC6814815 DOI: 10.1038/s41598-019-51982-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/10/2019] [Indexed: 02/06/2023] Open
Abstract
The optimum granulocyte colony-stimulating factor (G-CSF) treatment for cancer patients after being treated with cytotoxic chemotherapy remains unknown. Therefore, a systematic review and Bayesian network meta-analysis were performed to assess the efficacy and tolerability of 11 G-CSF drugs on patients after chemotherapy. A total of 73 randomized controlled trials (RCTs) containing 15,124 cancer patients were included for the final network meta-analysis. Compared with pegfilgrastim, there were a higher risk with filgrastim for incidence of febrile neutropenia (FN) (OR [95% CI]: 1.63 [1.07, 2.46]), and a higher risk with short-acting G-CSF (S-G-CSF) biosimilar and lenograstim for incidence of bone pain (BP) (OR [95% CI]: 6.45 [1.10, 65.73], 5.12 [1.14, 26.12], respectively). Mecapegfilgrastim, lipegfilgrastim and balugrastim were best G-CSF drugs in reducing FN (cumulative probabilities: 58%, 15%, 11%, respectively). S-G-CSF biosimilar, empegfilgrastim, and long-acting G-CSF (L-G-CSF) biosimilar were best G-CSF drugs in reducing severe neutropenia (SN) (cumulative probabilities: 21%, 20%, 15%, respectively). Mecapegfilgrastim, balugrastim, lipegfilgrastim and L-G-CSF biosimilar were best G-CSF drugs in reducing BP (cumulative probabilities: 20%, 14%, 8%, 8%, respectively). Mecapegfilgrastim, lipegfilgrastim and balugrastim might be the most appreciate G-CSF drugs with both good efficacy and tolerability when treating cancer patients after cytotoxic chemotherapy.
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11
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Liu KQ, Wang Y, Zhao Z, Lin D, Zhou CL, Liu BC, Gong XY, Zhao XL, Wei SN, Zhang GJ, Gong BF, Li Y, Liu YT, Mi YC, Wang JX, Wei H. [A single-center, randomized controlled trial of PEG-rhG-CSF and common rhG-CSF to promote neutrophil recovery after induction chemotherapy in newly diagnosed acute myeloid leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:497-501. [PMID: 31340623 PMCID: PMC7342402 DOI: 10.3760/cma.j.issn.0253-2727.2019.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
目的 比较初诊急性髓系白血病(AML)患者诱导化疗后骨髓抑制期应用聚乙二醇化重组人G-CSF(PEG-rhG-CSF)与普通重组人G-CSF(rhG-CSF)促进中性粒细胞或白细胞恢复的时间。同时比较两种药物对患者感染发生率、住院时间的影响。 方法 采用前瞻性随机对照研究方法,将2014年8月至2017年12月间符合入组条件的初诊AML患者诱导治疗后按1∶1比例随机分成两组:PEG-rhG-CSF组和rhG-CSF组。对比分析两组患者中性粒细胞计数(ANC)或WBC恢复时间、感染发生率和住院时间。 结果 共入组初诊AML患者60例,PEG-rhG-CSF组30例,rhG-CSF组30例。两组患者除性别构成外,在年龄、化疗方案、化疗前ANC、WBC、诱导化疗疗效方面差异均无统计学意义(P值均>0.05)。PEG-rhG-CSF组患者与rhG-CSF组患者的ANC、WBC恢复中位时间分别为19(14~35)d、19(15~26)d,差异无统计学意义(t=0.580,P=0.566)。PEG-rhG-CSF组、rhG-CSF组患者骨髓抑制期感染的发生率分别为90.0%、93.3%,差异无统计学意义(P=1.000)。两组患者的中位住院时间分别为20.5(17~49)d、21(19~43)d,差异无统计学意义(P=0.530)。 结论 AML患者诱导治疗后应用PEG-rhG-CSF与rhG-CSF无论在ANC或WBC恢复时间,还是在感染的发生率及住院时间均相当。
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Affiliation(s)
- K Q Liu
- Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
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12
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Combination of the low anticoagulant heparin CX-01 with chemotherapy for the treatment of acute myeloid leukemia. Blood Adv 2019; 2:381-389. [PMID: 29467192 DOI: 10.1182/bloodadvances.2017013391] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/21/2018] [Indexed: 12/19/2022] Open
Abstract
Relapses in acute myelogenous leukemia (AML) are a result of quiescent leukemic stem cells (LSCs) in marrow stromal niches, where they resist chemotherapy. LSCs employ CXCL12/CXCR4 to home toward protective marrow niches. Heparin disrupts CXCL12-mediated sequestration of cells in the marrow. CX-01 is a low-anticoagulant heparin derivative. In this pilot study, we combined CX-01 with chemotherapy for the treatment of AML. Induction consisted of cytarabine and idarubicin (7 + 3) with CX-01. Twelve patients were enrolled (median age, 56 years; 3 women). Three, 5, and 4 patients had good-, intermediate-, and poor-risk disease, respectively. Day 14 bone marrows were available on 11 patients and were aplastic in all without detectable leukemia. Eleven patients (92%) had morphologic complete remission after 1 induction (CR1). Eight patients were alive at a median follow-up of 24 months (4 patients in CR1). Three patients received an allogeneic stem cell transplant in CR1. Median disease-free survival was 14.8 months. Median overall survival was not attained at the maximum follow-up time of 29.4 months. No CX-01-associated serious adverse events occurred. Median day to an untransfused platelet count of at least 20 × 109/L was 21. CX-01 is well tolerated when combined with intensive therapy for AML and appears associated with enhanced count recovery and treatment efficacy.
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Nakov R, Gattu S, Wang J, Velinova M, Schaffar G, Skerjanec A. Proposed biosimilar pegfilgrastim shows similarity in pharmacokinetics and pharmacodynamics to reference pegfilgrastim in healthy subjects. Br J Clin Pharmacol 2018; 84:2790-2801. [PMID: 30079636 PMCID: PMC6256001 DOI: 10.1111/bcp.13731] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/27/2018] [Accepted: 07/16/2018] [Indexed: 02/02/2023] Open
Abstract
AIMS This study aimed to demonstrate that the pharmacokinetic (PK) and pharmacodynamic (PD) profile of Sandoz proposed biosimilar pegfilgrastim (LA-EP2006) matches reference pegfilgrastim (Neulasta® ) in healthy subjects. Safety and immunogenicity were also assessed. METHODS The phase I, randomized, double-blind, two-period crossover study consisted of two treatment periods separated by an 8-week washout period. Healthy subjects aged 18-45 were randomized to either proposed biosimilar/reference pegfilgrastim or reference pegfilgrastim/proposed biosimilar. Proposed biosimilar and reference pegfilgrastim were administered on Day 1 of each treatment period (single 6 mg subcutaneous injection). Blood samples for PK/PD analysis were taken predose and ≤336 h postdose. PK/PD similarity was claimed if 90% (PK) and 95% (PD) confidence intervals (CI) for geometric mean ratios of the area under the serum concentration-time curve (AUC) from time of dosing and extrapolated to infinity (AUC0-inf ), or to the last measurable concentration (AUC0-last ), maximum observed serum concentration (Cmax ), absolute neutrophil count (ANC) area under the effect curve from the time of dosing to the last measurable concentration (AUEC0-last ) and ANC maximum effect attributable to the therapy under investigation (Emax ) were completely contained within the predefined margin (0.8 to 1.25). RESULTS Overall, 169 subjects completed the study. PK/PD similarity was demonstrated; 90% CIs of geometric mean ratio of proposed biosimilar/reference for PK: AUC0-inf (1.0559-1.2244), AUC0-last (1.0607-1.2328), Cmax (1.0312-1.1909) and 95% CIs for PD (ANC): AUEC0-last (0.9948-1.0366), Emax (0.9737-1.0169) were completely contained within predefined margin of 0.8 to 1.25. Both biologics had similar safety profiles, were well tolerated and had low incidence of anti-drug antibodies. No neutralizing or clinically relevant antibodies were detected. CONCLUSIONS PK/PD similarity of Sandoz proposed biosimilar pegfilgrastim and reference pegfilgrastim was confirmed. No clinically meaningful differences in safety, tolerability and immunogenicity were observed in healthy subjects.
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14
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Cornes P, Gascon P, Chan S, Hameed K, Mitchell CR, Field P, Latymer M, Arantes LH. Systematic Review and Meta-analysis of Short- versus Long-Acting Granulocyte Colony-Stimulating Factors for Reduction of Chemotherapy-Induced Febrile Neutropenia. Adv Ther 2018; 35:1816-1829. [PMID: 30298233 PMCID: PMC6223993 DOI: 10.1007/s12325-018-0798-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Indexed: 11/26/2022]
Abstract
Introduction Short- and long-acting granulocyte-colony stimulating factors (G-CSFs) are approved for the reduction of febrile neutropenia. A systematic literature review was performed to identify randomized controlled trials (RCTs) and non-RCTs reporting the use of G-CSFs following chemotherapy treatment. Methods Medline®/Medline in-process, Embase®, and the Cochrane Library were searched for studies published between January 2003 and June 2016. A hand-search of relevant conference proceedings was conducted for meetings held between 2012 and 2016. Eligible studies were restricted to those reporting a direct, head-to-head comparison of short- versus long-acting G-CSFs for reduction of chemotherapy-induced febrile neutropenia. Risk-of-bias assessments were performed for full publications only. Results The search strategy yielded 4044 articles for electronic screening. Thirty-six publications were evaluated for the meta-analysis: 11 of 12 RCTs and 2 of 24 non-RCTs administered doses of the short-acting G-CSF filgrastim for ≥ 7 days. In RCT studies, there was no statistically significant difference in outcomes of interest between short- and long-acting G-CSFs. In non-RCTs, the overall risk was lower with long-acting G-CSF than with short-acting G-CSF for incidence of febrile neutropenia [overall relative risk (RR) = 0.67, P = 0.023], hospitalizations (overall RR = 0.68, P < 0.05), and chemotherapy dose delays (overall RR = 0.68, P = 0.020). Conclusions Overall, the weight of evidence from RCTs indicates little difference in efficacy between the short- and long-acting G-CSFs if dosed according to recommended guidelines. There is some evidence for greater efficacy for long-acting G-CSFs in non-RCTs, which may be a result of under-dosing of short-acting G-CSFs in general practice in real-world usage. Funding Hospira Inc, which was acquired by Pfizer Inc in September 2015, and Pfizer Inc. Electronic supplementary material The online version of this article (10.1007/s12325-018-0798-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paul Cornes
- Comparative Outcomes Group, 9 Royal Victoria Park, Bristol, BS10 6TD, UK.
| | - Pere Gascon
- Department of Hematology-Oncology, Hospital Clínic, University of Barcelona, C/Casanova 143, 08036, Barcelona, Spain
| | - Stephen Chan
- Nottingham University Hospitals, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Khalid Hameed
- Sheffield University, Weston Park Hospital, Whitham Road, Sheffield, S10 2SJ, UK
| | - Catherine R Mitchell
- PharmaGenesis Oxford Central, Chamberlain House, 5 St Aldates Courtyard, Oxford, OX1 1BN, UK
| | - Polly Field
- PharmaGenesis Oxford Central, Chamberlain House, 5 St Aldates Courtyard, Oxford, OX1 1BN, UK
| | - Mark Latymer
- Pfizer Ltd, Ramsgate Road, Sandwich, CT13 9NJ, UK
| | - Luiz H Arantes
- Pfizer Inc, 235 East 42nd Street, New York, NY, 10017, USA
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Busca A, Cesaro S, Teofili L, Delia M, Cattaneo C, Criscuolo M, Marchesi F, Fracchiolla NS, Valentini CG, Farina F, Di Blasi R, Prezioso L, Spolzino A, Candoni A, del Principe MI, Verga L, Nosari A, Aversa F, Pagano L. SEIFEM 2017: from real life to an agreement on the use of granulocyte transfusions and colony-stimulating factors for prophylaxis and treatment of infectious complications in patients with hematologic malignant disorders. Expert Rev Hematol 2018; 11:155-168. [DOI: 10.1080/17474086.2018.1420472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Alessandro Busca
- SSD Trapianto Cellule Staminali, A.O.U. Citta’ della Salute, Torino, Italy
| | - Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata Verona, Italy
| | - Luciana Teofili
- Department of Onco-Hematology, Fondazione Policlinico Universitario A. Gemelli-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mario Delia
- Dipartimento dell’Emergenza e dei Trapianti Di Organo, U.O Ematologia con Trapianto - Azienda Ospedaliero-Universitaria - Policlinico di Bari, Italy
| | | | - Marianna Criscuolo
- Department of Onco-Hematology, Fondazione Policlinico Universitario A. Gemelli-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit Regina Elena National Cancer Institute, Rome, Italy
| | | | - Caterina Giovanna Valentini
- Department of Onco-Hematology, Fondazione Policlinico Universitario A. Gemelli-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Farina
- Unità di ematologia e trapianti di midollo osseo, IRCCS San Raffaele, Milano, Italy
| | - Roberta Di Blasi
- Department of Onco-Hematology, Fondazione Policlinico Universitario A. Gemelli-Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Anna Candoni
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari, Azienda Sanitaria Universitaria Integrata di Udine, Italy
| | | | - Luisa Verga
- Ematologia adulti e CTA ASST Monza, Universita’ Milano Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Annamaria Nosari
- Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano.Italy
| | | | - Livio Pagano
- Department of Onco-Hematology, Fondazione Policlinico Universitario A. Gemelli-Università Cattolica del Sacro Cuore, Rome, Italy
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Santos DA, Alseidi A, Shannon VR, Messick C, Song G, Ledet CR, Lee H, Ngo-Huang A, Francis GJ, Asher A. Management of surgical challenges in actively treated cancer patients. Curr Probl Surg 2017; 54:612-654. [DOI: 10.1067/j.cpsurg.2017.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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17
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Sperr WR, Herndlhofer S, Gleixner K, Girschikofsky M, Weltermann A, Machherndl-Spandl S, Sliwa T, Poehnl R, Buxhofer-Ausch V, Strecker K, Hoermann G, Knoebl P, Jaeger U, Geissler K, Kundi M, Valent P. Intensive consolidation with G-CSF support: Tolerability, safety, reduced hospitalization, and efficacy in acute myeloid leukemia patients ≥60 years. Am J Hematol 2017; 92:E567-E574. [PMID: 28699225 DOI: 10.1002/ajh.24847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/04/2017] [Accepted: 07/06/2017] [Indexed: 11/09/2022]
Abstract
The aim of this study was to evaluate the efficacy and feasibility of intensified consolidation therapy employing fludarabine and ARA-C in cycle 1 and intermediate-dose ARA-C (IDAC) in cycles 2 through 4, in elderly acute myeloid leukemia (AML) patients and to analyze the effects of pegfilgrastim on the duration of neutropenia, overall toxicity, and hospitalization-time during consolidation in these patients. Thirty nine elderly patients with de novo AML (median age 69.9 years) who achieved complete remission (CR) after induction-chemotherapy were analyzed. To examine the effect of pegfilgrastim on neutropenia and hospitalization, we compared cycles 2 and 4 where pegfilgrastim was given routinely from day 6 (IDAC-P) with cycle 3 where pegfilgrastim was only administered in case of severe infections and/or prolonged neutropenia. All four planned cycles were administered in 23/39 patients (59.0%); 5/39 patients (12.8%) received 3 cycles, 3/39 (7.7%) 2 cycles, and 8/39 (20.5%) one consolidation-cycle. The median duration of severe neutropenia was 7 days in cycle 2 (IDAC-P), 11.5 days in cycle 3 (IDAC), and 7.5 days in cycle 4 (IDAC-P) (P < .05). Median overall survival was 1.1 years and differed significantly between patients aged <75 and ≥75 years (P < .05). The probability to be alive after 5 years was 32%. Together, intensified consolidation can be administered in AML patients ≥60, and those who are <75 may benefit from this therapy. Routine administration of pegfilgrastim during consolidation shortens the time of neutropenia and hospitalization in these patients.
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Affiliation(s)
- Wolfgang R. Sperr
- Department of Internal Medicine I, Division of Hematology and Hemostaseology; Medical University of Vienna; Wien Austria
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna; Wien Austria
| | - Susanne Herndlhofer
- Department of Internal Medicine I, Division of Hematology and Hemostaseology; Medical University of Vienna; Wien Austria
| | - Karoline Gleixner
- Department of Internal Medicine I, Division of Hematology and Hemostaseology; Medical University of Vienna; Wien Austria
| | | | - Ansgar Weltermann
- 1st Medical Department; Hospital of the Elisabethinen Linz; Linz Austria
| | | | - Thamer Sliwa
- 5th Medical Department; Krankenhaus Hietzing; Wien Austria
| | - Rainer Poehnl
- 3rd Medical Department; Kaiser-Franz-Josef-Spital; Wien Austria
| | - Veronika Buxhofer-Ausch
- 1st Medical Department; Hospital of the Elisabethinen Linz; Linz Austria
- 2nd Medical Department; Donauspital; Wien Austria
| | | | - Gregor Hoermann
- Department of Laboratory Medicine; Medical University of Vienna; Wien Austria
| | - Paul Knoebl
- Department of Internal Medicine I, Division of Hematology and Hemostaseology; Medical University of Vienna; Wien Austria
| | - Ulrich Jaeger
- Department of Internal Medicine I, Division of Hematology and Hemostaseology; Medical University of Vienna; Wien Austria
| | - Klaus Geissler
- 5th Medical Department; Krankenhaus Hietzing; Wien Austria
| | - Michael Kundi
- Institute of Environmental Health, Medical University of Vienna; Wien Austria
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology; Medical University of Vienna; Wien Austria
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna; Wien Austria
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Condensed versus standard schedule of high-dose cytarabine consolidation therapy with pegfilgrastim growth factor support in acute myeloid leukemia. Blood Cancer J 2017; 7:e564. [PMID: 28548643 PMCID: PMC5518888 DOI: 10.1038/bcj.2017.45] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 04/21/2017] [Indexed: 11/12/2022] Open
Abstract
The aim of this cohort study was to compare a condensed schedule of consolidation therapy with high-dose cytarabine on days 1, 2 and 3 (HDAC-123) with the HDAC schedule given on days 1, 3 and 5 (HDAC-135) as well as to evaluate the prophylactic use of pegfilgrastim after chemotherapy in younger patients with acute myeloid leukemia in first complete remission. One hundred and seventy-six patients were treated with HDAC-135 and 392 patients with HDAC-123 with prophylactic pegfilgrastim at days 10 and 8, respectively, in the AMLSG 07-04 and the German AML Intergroup protocol. Time from start to chemotherapy until hematologic recovery with white blood cells >1.0 G/l and neutrophils >0.5 G/l was in median 4 days shorter in patients receiving HDAC-123 compared with HDAC-135 (P<0.0001, each), and further reduced by 2 days (P<0.0001) by pegfilgrastim. Rates of infections were reduced by HDAC-123 (P<0.0001) and pegfilgrastim (P=0.002). Days in hospital and platelet transfusions were significantly reduced by HDAC-123 compared with HDAC-135. Survival was neither affected by HDAC-123 versus HDAC-135 nor by pegfilgrastim. In conclusion, consolidation therapy with HDAC-123 leads to faster hematologic recovery and less infections, platelet transfusions as well as days in hospital without affecting survival.
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19
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Heiblig M, Elhamri M, Le Jeune C, Laude MC, Deloire A, Wattel E, Salles G, Thomas X. Acute myeloid leukemia in the elderly (age 70 yr or older): long-term survivors. Eur J Haematol 2016; 98:134-141. [DOI: 10.1111/ejh.12811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Maël Heiblig
- Clinical Hematology; Hospices Civils de Lyon; Lyon-Sud Hospital; Pierre-Bénite France
| | | | - Caroline Le Jeune
- Clinical Hematology; Hospices Civils de Lyon; Lyon-Sud Hospital; Pierre-Bénite France
| | - Marie-Charlotte Laude
- Clinical Hematology; Hospices Civils de Lyon; Lyon-Sud Hospital; Pierre-Bénite France
| | | | - Eric Wattel
- Clinical Hematology; Hospices Civils de Lyon; Lyon-Sud Hospital; Pierre-Bénite France
| | - Gilles Salles
- Clinical Hematology; Hospices Civils de Lyon; Lyon-Sud Hospital; Pierre-Bénite France
| | - Xavier Thomas
- Clinical Hematology; Hospices Civils de Lyon; Lyon-Sud Hospital; Pierre-Bénite France
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20
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Petru E, Singer CF, Polterauer S, Galid A, Schauer C, Klocker J, Seifert M, Reinthaller A, Benedicic C, Hubalek M, Hefler L, Marth C, Scholl-Firon T, Bogner G, Zeimet AG. Prophylactic long-acting granulocyte-colony stimulating factors (G-CSF) in gynecologic malignancies: an oncologic expert statement. Wien Med Wochenschr 2015; 165:387-94. [PMID: 26471371 DOI: 10.1007/s10354-015-0392-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 09/14/2015] [Accepted: 09/15/2015] [Indexed: 12/01/2022]
Abstract
We reviewed the status of the use of the prophylactic long-acting granulocyte colony-stimulating factors (G-CSFs) pegfilgrastim and lipegfilgrastim in gynecologic malignancies. Long-acting G-CSFs should not be used in weekly regimens. Filgrastim is not indicated in patients with febrile and/or severe neutropenia after administration of long-acting G-CSF in the same cycle. One study has shown a moderate effect on febrile neutropenia of ciprofloxacin when co-administered with pegfilgrastim. There is broad evidence from meta-analyses that pegfilgrastim effectively reduces severe neutropenia. In parallel, its adverse effects have been studied extensively. All-cause mortality was significantly reduced by pegfilgrastim. The glycopegylated long-acting G-CSF, lipegfilgrastim has demonstrated antineutropenic efficacy similar to that of pegfilgrastimin in one breast cancer study. In another pivitol non-small cell lung cancer study, impaired survival was observed in the lipegfilgrastim group during the first 30 days of study. The European Medicines Agency claimed more profound safety data to be provided for lipegfilgrastim by 2017.
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Affiliation(s)
- Edgar Petru
- Division of Gynecology, Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria.
| | - Christian F Singer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Stephan Polterauer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Arik Galid
- Department of Obstetrics and Gynecology, Hanuschkrankenhaus, Vienna, Austria
| | - Christian Schauer
- Department of Gynecology, Hospital Barmherzige Brüder Graz, Graz, Austria
| | - Johann Klocker
- Department of Internal Medicine, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Michael Seifert
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Alexander Reinthaller
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Christoph Benedicic
- Division of Gynecology, Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria
| | - Michael Hubalek
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lukas Hefler
- Department of Gynecology, Hospital Barmherzige Schwestern, Linz, Austria
| | - Christian Marth
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Tonja Scholl-Firon
- Department of Obstetrics and Gynecology, Wilhelminenspital, Vienna, Austria
| | - Gerhard Bogner
- Department of Obstetrics and Gynecology, Paracelsus University of Salzburg, Salzburg, Austria
| | - Alain-Gustave Zeimet
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
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Granulocyte colony-stimulating factors as prophylaxis against febrile neutropenia. Support Care Cancer 2014; 23:547-59. [PMID: 25284722 DOI: 10.1007/s00520-014-2459-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 09/22/2014] [Indexed: 10/24/2022]
Abstract
Myelosuppression secondary to chemotherapy remains a serious adverse effect of cancer therapy that causes high morbidity and mortality. Several current European and American guidelines recommend consideration of primary prophylaxis with colony-stimulating factors (CSFs) when the risk of febrile neutropenia is higher than 20 %. The main factors associated with a high risk of febrile neutropenia include the chemotherapy regimen, tumor type, and patient-related factors such as old age and/or comorbidities. The purpose of this paper is to summarize the most relevant clinical trials and updated recommendations of the main guidelines on the role of granulocyte colony-stimulating factors (G-CSFs) in febrile neutropenia, examining whether the combination of G-CSF with chemotherapy improves overall survival. Future directions for G-CSF use are also discussed.
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Vehreschild JJ, Böhme A, Cornely OA, Kahl C, Karthaus M, Kreuzer KA, Maschmeyer G, Mousset S, Ossendorf V, Penack O, Vehreschild MJGT, Bohlius J. Prophylaxis of infectious complications with colony-stimulating factors in adult cancer patients undergoing chemotherapy-evidence-based guidelines from the Infectious Diseases Working Party AGIHO of the German Society for Haematology and Medical Oncology (DGHO). Ann Oncol 2014; 25:1709-1718. [PMID: 24631945 DOI: 10.1093/annonc/mdu035] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Current evidence on myelopoietic growth factors is difficult to overview for the practicing haematologist/oncologist. International guidelines are sometimes conflicting, exclude certain patient groups, or cannot directly be applied to the German health system. This guideline by the Infectious Diseases Working Party (AGIHO) of the German Society of Haematology and Medical Oncology (DGHO) gives evidence-based recommendations for the use of G-CSF, pegylated G-CSF, and biosimilars to prevent infectious complications in cancer patients undergoing chemotherapy, including those with haematological malignancies. METHODS We systematically searched and evaluated current evidence. An expert panel discussed the results and recommendations. We then compared our recommendations to current international guidelines. RESULTS We summarised the data from eligible studies in evidence tables, developed recommendations for different entities and risk groups. CONCLUSION Comprehensive literature search and expert panel consensus confirmed many key recommendations given by international guidelines. Evidence for growth factors during acute myeloid leukaemia induction chemotherapy and pegfilgrastim use in haematological malignancies was rated lower compared with other guidelines.
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Affiliation(s)
- J J Vehreschild
- 1st Department of Internal Medicine, University Hospital of Cologne, Cologne
| | - A Böhme
- Onkologikum Frankfurt am Museumsufer, Frankfurt a.M
| | - O A Cornely
- 1st Department of Internal Medicine, University Hospital of Cologne, Cologne; Clinical Trials Centre Cologne (ZKS Köln, BMBF 01KN1106); Centre for Integrated Oncology CIO KölnBonn, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne.
| | - C Kahl
- Clinic for Haematology and Oncology, Klinikum Magdeburg gGmbH
| | - M Karthaus
- Haematology-Oncology and Palliative Care, Hospital Neuperlach and Hospital Harlaching, Munich
| | - K-A Kreuzer
- 1st Department of Internal Medicine, University Hospital of Cologne, Cologne
| | - G Maschmeyer
- Department of Haematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam
| | - S Mousset
- Medizinische Klinik II, University Hospital Frankfurt a.M., Frankfurt a.M
| | - V Ossendorf
- Clinical Trials Centre Cologne (ZKS Köln, BMBF 01KN1106)
| | - O Penack
- Campus Benjamin Franklin; Medical Clinic for Haematology and Oncology, University Hospital Charité, Berlin, Germany
| | - M J G T Vehreschild
- 1st Department of Internal Medicine, University Hospital of Cologne, Cologne
| | - J Bohlius
- Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Kam G, Yiu R, Loh Y, Ang AL, Yueh LL, Goh YT, Wong GC. Impact of pegylated filgrastim in comparison to filgrastim for patients with acute myeloid leukaemia (AML) on high-dose cytarabine (HIDAC) consolidation chemotherapy. Support Care Cancer 2014; 23:643-9. [PMID: 25160495 DOI: 10.1007/s00520-014-2417-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 08/18/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Grace Kam
- Department of Haematology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore,
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24
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Comparison and modelling of pegylated or unpegylated G-CSF schedules in CHOP-14 regimen of elderly patients with aggressive B-cell lymphoma. Ann Hematol 2013; 92:1641-52. [DOI: 10.1007/s00277-013-1842-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 07/02/2013] [Indexed: 11/26/2022]
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25
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Bradley AM, Deal AM, Buie LW, van Deventer H. Neutropenia-associated outcomes in adults with acute myeloid leukemia receiving cytarabine consolidation chemotherapy with or without granulocyte colony-stimulating factor. Pharmacotherapy 2013. [PMID: 23208834 DOI: 10.1002/phar.1150] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
STUDY OBJECTIVE To determine whether granulocyte colony-stimulating factor (G-CSF) prophylaxis after consolidation with high- or intermediate-dose cytarabine (H/IDAC) for treatment of acute myeloid leukemia (AML) reduces the frequency of neutropenia-associated complications. DESIGN Retrospective medical record review. SETTING Academic medical center. PATIENTS Seventy-eight patients aged 18 years or older in whom H/IDAC consolidation chemotherapy was initiated for consolidation of AML between November 2004 and November 2010. MEASUREMENTS AND MAIN RESULTS Patient demographic data, information on the hospitalization for consolidation, data on G-CSF use after H/IDAC chemotherapy, and details on any readmissions were collected. Patients were deemed to have received G-CSF prophylaxis if there was documentation of the intent for use of either filgrastim or pegfilgrastim. Outcome data also were collected, including dates of relapse or second induction treatment course, and death or last follow-up visit. We compared data based on patient receipt of G-CSF (G-CSF vs no G-CSF) after each chemotherapy cycle. We assessed differences in the duration of hospitalization, fever, intravenous antibiotic use, and neutropenia, as well as rate of documented infections, time to disease recurrence, and overall survival. Compared with no G-CSF, use of G-CSF after cycle 1 of H/IDAC significantly reduced the rate of hospitalization for febrile neutropenia (p=0.039); however, no significant differences were noted for subsequent cycles. No significant differences were seen in duration of hospitalization, rate of documented infections, or time to treatment failure between groups. Overall survival was longer for patients who received G-CSF during their first cycle (p=0.018) and for those who received G-CSF during any of their cycles (p=0.04). CONCLUSION Use of G-CSF prophylaxis after cycle 1 of H/IDAC consolidation for AML appears to reduce the frequency of hospitalization for febrile neutropenia and to increase overall survival compared with no G-CSF use. Prospective, controlled studies are needed to support our findings.
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Affiliation(s)
- Amber M Bradley
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA 30912, USA.
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26
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Szwajcer D, Czaykowski P, Turner D. Assessment and management of febrile neutropenia in emergency departments within a regional health authority-a benchmark analysis. ACTA ACUST UNITED AC 2012; 18:280-4. [PMID: 22184489 DOI: 10.3747/co.v18i6.841] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Febrile neutropenia is considered an oncologic emergency, for which prompt initiation of antibiotics is essential. METHODS We conducted a retrospective cohort study for the 2006 calendar year involving all adult oncology patients presenting with febrile neutropenia to a regional health authority's emergency departments. The objective was to determine the time from triage to antibiotic administration and its impact on patient outcomes. RESULTS We identified 68 patients presenting with febrile neutropenia, most of whom (76%) were seen in tertiary care centers. Of those patients, 65% were triaged to be seen within 15 minutes of arrival in the emergency room; however, the median time to reassessment was 57 minutes. The median time from triage to antibiotic administration was 5 hours (range: 1.23-22.8 hours). No increased risk of death or increased length of hospital stay was associated with delayed antibiotic administration. Older patients and patients without caregiver support were more likely to experience delayed antibiotic administration (odds ratio: 3.8 and 12.7 respectively). CONCLUSIONS We were not able to show a deleterious effect of delay in antibiotic administration, but our analysis identified several points at which patient flow through the emergency room could be improved.
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Affiliation(s)
- D Szwajcer
- Department of Medical Oncology and Haematology, University of Manitoba, Winnipeg, MB
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27
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Abstract
Achieving optimal patient benefit from biological therapies can be hindered by drug instability, rapid clearance requiring frequent dosing or potential immune reactions. One strategy for addressing these challenges is drug modification through PEGylation, a well established process by which one or more molecules of polyethylene glycol (PEG) are covalently attached to a biological or small-molecule drug, effectively transforming it into a therapy with improved pharmacokinetic and pharmacodynamic properties. Numerous PEGylated therapeutics are currently available, all of which have at least comparable efficacy, safety and tolerability to their unmodified forms. A PEGylated form of interferon-β-1a (PEG-IFNβ-1a) is being developed to address an unmet medical need for safer, more effective and more convenient therapies for multiple sclerosis (MS). Phase I study data suggest that PEG-IFNβ-1a should provide patients with a first-line therapy with a more convenient dosing regimen while maintaining the established efficacy, safety and tolerability of presently available IFNβ-1a. The ongoing global ADVANCE phase III study will determine the clinical efficacy of PEG-IFNβ-1a in patients with relapsing MS.
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28
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Yang BB, Savin MA, Green M. Prevention of Chemotherapy-Induced Neutropenia with Pegfilgrastim: Pharmacokinetics and Patient Outcomes. Chemotherapy 2012; 58:387-98. [DOI: 10.1159/000345626] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 11/05/2012] [Indexed: 12/21/2022]
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Harada M, Ohuchi M, Hayashi T, Kato Y. Prolonged circulation and in vivo efficacy of recombinant human granulocyte colony-stimulating factor encapsulated in polymeric micelles. J Control Release 2011; 156:101-8. [PMID: 21723892 DOI: 10.1016/j.jconrel.2011.06.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 06/08/2011] [Accepted: 06/13/2011] [Indexed: 02/01/2023]
Abstract
To improve the pharmacokinetics of granulocyte colony-stimulating factor (G-CSF) and decrease dosing frequency, polyethylene glycol polyglutamate block copolymers were used as delivery carriers. The block copolymers are partially substituted with hydrophobic octyl or benzyl groups to form a micellar structure in aqueous media and encapsulate the protein. G-CSF is encapsulated in the polymeric micelles with a diameter of 60-70nm. The present study was designed to evaluate the plasma pharmacokinetics, G-CSF release and in vivo efficacy of G-CSF-encapsulating micelles. Pharmacokinetic studies in rats showed highly enhanced plasma retention of the micelles compared with native G-CSF. The AUC (area under the curve) of the octyl-based polymer formulation showed a 5-fold increase, compared with native G-CSF. Size-exclusion chromatography of the blood from rats injected with the micelles demonstrated the release of G-CSF from the micelles in the blood circulation. The pharmacokinetic behavior supports the in vivo studies showing that the micelles display a comparable efficacy to PEGylated G-CSF. Simultaneous pharmacokinetic analysis of released and encapsulated G-CSF plasma levels showed that the G-CSF release occurs with the first-order kinetics and the half-life is 4.8h. In conclusion, G-CSF is endowed by the polymeric micelles with prolonged half-life and increased efficacy without any chemical modification.
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Affiliation(s)
- Mitsunori Harada
- Research Division, NanoCarrier Co. Ltd., 5-4-19 Kashiwanoha, Kashiwa, Chiba, Japan
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Derbel O, Cannas G, Le QH, Elhamri M, Chelghoum Y, Nicolas-Virelizier E, Nicolini F, Troncy J, Barraco F, Michallet M, Thomas X. A single dose pegfilgrastim for supporting neutrophil recovery in patients treated for high-risk acute myeloid leukemia by the EMA 2000 schedule. ACTA ACUST UNITED AC 2010; 15:125-31. [PMID: 20557669 DOI: 10.1179/102453309x12583347113654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Dose intensity has been demonstrated to be one determinant for treatment efficacy in younger adults with high-risk (relapsed and refractory) acute myelogenous leukemia. Between 2000 and 2006, 56 patients entered the EMA 2000 study and received timed sequential reinduction chemotherapy. From 2004, chemotherapy was also followed by one subcutaneous dose of pegfilgrastim. Thirty-six patients reached a complete remission, while nine obtained a partial remission. Median time to granulocyte and platelet recovery was 34 and 38 days respectively. The major non-hematologic toxicities were severe infections but despite this 23 remitters could proceed to their post-remission treatment, although 13 did not because of severe toxicity or early relapse. The median overall survival was 9.3 months. The EMA 2000 regimen is a highly effective treatment with a response rate of 64% and a low early death rate. The period of critical neutropenia was relatively short in both phases and the supportive use of pegfilgrastim, although showing a trend toward reduced neutropenic period, did not appear to reduce the risk of infection in this group and may not be a critical requirement for reducing the risk of treatment-related toxicity.
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Affiliation(s)
- Olfa Derbel
- Service d'Hématologie, Hôpital Edouard Herriot, Lyon, France
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Gregory SA, Schwartzberg LS, Mo M, Sierra J, Vogel C. Evaluation of reported bone pain in cancer patients receiving chemotherapy in pegf lgrastim clinical trials: a retrospective analysis. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1548-5315(11)70402-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Klastersky J, Awada A. Prevention of febrile neutropenia in chemotherapy-treated cancer patients: Pegylated versus standard myeloid colony stimulating factors. Do we have a choice? Crit Rev Oncol Hematol 2010; 78:17-23. [PMID: 20227290 DOI: 10.1016/j.critrevonc.2010.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 01/21/2010] [Accepted: 02/11/2010] [Indexed: 11/26/2022] Open
Abstract
The pertinent literature on clinical studies comparing the respective value of myeloid colony stimulating factors to pegfilgrastim as a prevention of febrile neutropenia in chemotherapy-treated cancer patients has been reviewed. Pegfilgrastim is definitely not inferior to filgrastim or other myeloid colony stimulating agents with respect to duration of grade IV neutropenia and delivery of full chemotherapy dose on time; several comparative studies indicate a trend to less frequent febrile neutropenia with pegfilgrastim.
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Affiliation(s)
- Jean Klastersky
- Department of Medicine, Jules Bordet Institute, Centre des Tumeurs de l'Université Libre de Bruxelles, Belgium.
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Spunt SL, Irving H, Frost J, Sender L, Guo M, Yang BB, Dreiling L, Santana VM. Phase II, randomized, open-label study of pegfilgrastim-supported VDC/IE chemotherapy in pediatric sarcoma patients. J Clin Oncol 2010; 28:1329-36. [PMID: 20142595 PMCID: PMC2834494 DOI: 10.1200/jco.2009.24.8872] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2009] [Accepted: 11/06/2009] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This multicenter, randomized, open-label study evaluated the efficacy, safety, and pharmacokinetics of a single subcutaneous pegfilgrastim injection with daily subcutaneous filgrastim administration in pediatric patients receiving myelosuppressive chemotherapy for sarcoma. PATIENTS AND METHODS Forty-four patients with previously untreated, biopsy-proven sarcoma stratified into three age groups (0-5, 6-11, and 12-21 years) were randomly assigned in a 6:1 randomization ratio to receive a single pegfilgrastim dose of 100 microg/kg (n = 38) or daily filgrastim doses of 5 microg/kg (n = 6) after chemotherapy (cycles 1 and 3: vincristine-doxorubicin-cyclophosphamide; cycles 2 and 4: ifosfamide-etoposide). The duration of grade 4 neutropenia, time to neutrophil recovery, incidence of febrile neutropenia, and adverse events were recorded. Results Pegfilgrastim and filgrastim were similar for all efficacy and safety end points, and their pharmacokinetic profiles were consistent with those in adults. Younger children experienced more protracted neutropenia and had higher median pegfilgrastim exposure than older children. CONCLUSION A single dose of pegfilgrastim at 100 microg/kg administered once per chemotherapy cycle is comparable to daily injections of filgrastim at 5 microg/kg for pediatric sarcoma patients receiving myelosuppressive chemotherapy.
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Affiliation(s)
- Sheri L Spunt
- Department of Oncology, St Jude Children's Research Hospita, Universityof Tennessee Health Sciences Center, Memphis, TN 38105-3678, USA.
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The effect of recombinant granulocyte colony-stimulating factor on oral and periodontal manifestations in a patient with cyclic neutropenia: a case report. Int J Dent 2010; 2009:654239. [PMID: 20339570 PMCID: PMC2836918 DOI: 10.1155/2009/654239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 07/28/2009] [Accepted: 11/30/2009] [Indexed: 11/17/2022] Open
Abstract
Cyclic Neutropenia (CN) is characterized by recurrent infections, fever, oral ulcerations, and severe periodontitis as result of the reduced host defences. The previous studies have established the effectiveness of recombinant granulocyte colony-stimulating factor (GCSF) to increase the number and the function of neutrophils in the peripheral blood in this disease. In a 20-year-old Caucasian female with a diagnosis of cyclic neutropenia, oral clinical examination revealed multiple painful ulcerations of the oral mucosa, poor oral hygiene conditions, marginal gingivitis, and moderate periodontitis. The patient received a treatment with G-CSF (Pegfilgrastim, 6 mg/month) in order to improve her immunological status. Once a month nonsurgical periodontal treatment was carefully performed when absolute neutrophil count (ANC)
was ≥500/μL. The treatment with G-CSF resulted in a rapid
increase of circulating neutrophils that, despite its short
duration, leaded to a reduction in infection related events and
the resolution of the multiple oral ulcerations. The disappearance
of oral pain allowed an efficacy nonsurgical treatment and a
normal tooth brushing that determined a reduction of probing depth
(PD ≤ 4 mm) and an improvement of the oral hygiene conditions recorded at 6-month follow-up.
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Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood 2010; 115:453-74. [PMID: 19880497 DOI: 10.1182/blood-2009-07-235358] [Citation(s) in RCA: 2493] [Impact Index Per Article: 178.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AbstractIn 2003, an international working group last reported on recommendations for diagnosis, response assessment, and treatment outcomes in acute myeloid leukemia (AML). Since that time, considerable progress has been made in elucidating the molecular pathogenesis of the disease that has resulted in the identification of new diagnostic and prognostic markers. Furthermore, therapies are now being developed that target disease-associated molecular defects. Recent developments prompted an international expert panel to provide updated evidence- and expert opinion–based recommendations for the diagnosis and management of AML, that contain both minimal requirements for general practice as well as standards for clinical trials. A new standardized reporting system for correlation of cytogenetic and molecular genetic data with clinical data is proposed.
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Zhai Y, Zhao Y, Lei J, Su Z, Ma G. Enhanced circulation half-life of site-specific PEGylated rhG-CSF: optimization of PEG molecular weight. J Biotechnol 2009; 142:259-66. [PMID: 19497340 DOI: 10.1016/j.jbiotec.2009.05.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 05/20/2009] [Accepted: 05/26/2009] [Indexed: 01/22/2023]
Abstract
Recombinant human granulocyte colony stimulating factor (rhG-CSF) and its PEGylated product "mono-PEG20-GCSF" have already been widely used for treatment of all kinds of neutropenia. However, the high required dosage of mono-PEG20-GCSF made it relatively expensive in clinical use. We postulated that an N-terminal site-specific PEGylated rhG-CSF with higher PEG Mw (PEG30 kDa) might be able to achieve longer circulation half-life while retaining its bioactivity, allowing the reduction of dosage for clinical use. rhG-CSF was PEGylated at the N-terminus by 5 kDa, 10 kDa, 20 kDa and 30 kDa methoxy-poly(ethylene glycol)-propionaldehyde (mPEG-ALD), and the four PEGylates were compared with respect to reaction, separation, characterization and also in vivo/in vitro activity, results showed that the mPEG-ALD of higher Mw demonstrated better N-terminal site-specific selectivity, separation purity and yield. The production cost and in vitro activity of mono-PEG30-GCSF and mono-PEG20-GCSF were almost the same, while mono-PEG30-GCSF showed longer in vivo circulation half-life and 60% higher drug bioavailability than mono-PEG20-GCSF. Consequently, mono-PEG30-GCSF shall be administered at a lower dosage than mono-PEG20-GCSF while retaining the same therapeutic efficacy.
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Affiliation(s)
- Yanqin Zhai
- National Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing 100190, China
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Almenar D, Mayans J, Juan O, Bueno JMG, Lopez JIJ, Frau A, Guinot M, Cerezuela P, Buscalla EG, Gasquet JA, Sanchez J. Pegfilgrastim and daily granulocyte colony-stimulating factor: patterns of use and neutropenia-related outcomes in cancer patients in Spain--results of the LEARN Study. Eur J Cancer Care (Engl) 2008; 18:280-6. [PMID: 19076208 PMCID: PMC2702003 DOI: 10.1111/j.1365-2354.2008.00959.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Daily granulocyte colony-stimulating factors [(G-CSFs); e.g. filgrastim, lenograstim] are frequently used to reduce the duration of chemotherapy-induced neutropenia (CIN) and the incidence of febrile neutropenia (FN) in cancer patients. A pegylated formulation of filgrastim, pegfilgrastim, which is administered once per cycle, was introduced in Spain in 2003. LEARN was a multi-centre, retrospective, observational study in Spain comparing patterns of use of daily G-CSF and pegfilgrastim, and CIN-related outcomes in adults with non-myeloid malignancies receiving myelosuppressive chemotherapy. Outcome measures were the percentage of patients receiving G-CSF for primary prophylaxis versus secondary prophylaxis/treatment, duration of treatment with G-CSF and incidence of CIN-related complications. Medical records from consecutive patients with documented pegfilgrastim (n = 75) or daily G-CSF (n = 111) use during 2003 were included. The proportion of patients receiving primary or secondary prophylaxis was comparable between the pegfilgrastim (39 and 48% respectively) and daily G-CSF (40 and 48% respectively) groups. However, there was a trend towards less frequent use to treat a neutropenic event such as FN or neutropenia in the pegfilgrastim group (17 versus 30% with daily G-CSF). Chemotherapy-induced neutropenia-related complications were less frequent in patients receiving pegfilgrastim (e.g. FN 11 versus 24% with daily G-CSF). This is the first study to show the potential benefits of pegfilgrastim over daily G-CSF in Spanish clinical practice.
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Affiliation(s)
- D Almenar
- Department of Oncology, Hospital Universitario Dr Peset, Valencia, Spain.
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