Myelodysplastic Syndrome and Acute Myeloid Leukemia Following Use of Granulocyte Colony-Stimulating Factors in Older Non-Hodgkin Lymphoma Patients

Details

• Alternative Title:
  Cancer
• Personal Author:
  Calip, Gregory S. ; Moran, Kellyn M. ; Sweiss, Karen ; Patel, Pritesh R. ; Wu, Zhaoju ; Adimadhyam, Sruthi ; Lee, Todd A. ; Ko, Naomi Y. ; Quigley, John G. ; Chiu, Brian C.-H.
• Description:
  Background
  
  Granulocyte colony-stimulating factors(G-CSF), used for prevention of complications from chemotherapy-related neutropenia, are linked to risk of developing second primary myelodysplastic syndrome and acute myeloid leukemia(MDS/AML). Our purpose was to examine the relationship between use of a specific G-CSF agent and risk of MDS/AML among older patients with non-Hodgkin lymphoma(NHL).
  
  Methods
  
  We conducted a retrospective cohort study of adults aged >65 years with first primary NHL between 2001–2011, using the Surveillance Epidemiology and End Results-Medicare linked database. We estimated adjusted hazard ratios(HR) and 95% confidence intervals(CI) for MDS/AML risk associated with G-CSF(filgrastim and pegfilgrastim) use in Cox proportional hazards models stratified by treatment accounting for confounding by indication.
  
  Results
  
  Among 18,245 NHL patients with median follow up of 3.5 years, 56% received chemotherapy and/or immunotherapy, and G-CSF was most commonly used in those receiving rituximab plus multiple chemotherapy regimens(77%). Subsequent MDS/AML diagnoses were identified in 666(3.7%) patients. We observed modest increased risk of MDS/AML with use of G-CSF(HR=1.28, 95% CI 1.01–1.62) and a trend with increasing doses(P-trend <0.01). When analyzing specific agents, increased MDS/AML risk was consistently observed with filgrastim(10+ doses: HR=1.67, 95% CI 1.25–2.23), but not pegfilgrastim(10+ doses: HR=1.11, 95% CI 0.84–1.45).
  
  Conclusions
  
  We found higher MDS/AML risk among those receiving G-CSF that was specific to the use of filgrastim(≥10 doses), but not pegfilgrastim. Neutropenia prophylaxis is an essential component of highly effective NHL treatment regimens. Differential risk related to the type of G-CSF agents used warrants further study given their increasing use and newly available FDA-approved biosimilar products.
  
  
• Subjects:
  Aged Aged, 80 And Over Antineoplastic Agents, Immunological Antineoplastic Combined Chemotherapy Protocols Female Filgrastim Granulocyte Colony-Stimulating Factor Hematologic Agents Humans Information Storage And Retrieval Leukemia, Myeloid, Acute Lymphoma, Non-Hodgkin Male Medicare Myelodysplastic Syndromes Neoplasms, Second Primary Neutropenia Polyethylene Glycols Rituximab

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• Source:
  Cancer. 125(7):1143-1154
• Pubmed ID:
  30548485
• Pubmed Central ID:
  PMC6420387
• Document Type:
  Journal Article
• Funding:
  HHSN261201000035C/CA/NCI NIH HHS/United States ; R21 MD011439/MD/NIMHD NIH HHS/United States ; HHSN261201000035I/CA/NCI NIH HHS/United States ; UL1 TR002003/TR/NCATS NIH HHS/United States ; HHSN261201000034C/CA/NCI NIH HHS/United States ; HHSN261201000140C/CA/NCI NIH HHS/United States ; KL2 TR002002/TR/NCATS NIH HHS/United States ; U58 DP003862/DP/NCCDPHP CDC HHS/United States ; KL2 TR000048/TR/NCATS NIH HHS/United States
• Name as Subject:
  SEER Program
• Place as Subject:
  United States
• Volume:
  125
• Issue:
  7
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:66af518cf0ce5cdf860a5e71e4f5dd5331378380f3b7f6f248b96f8fecd8e9ad
• Download URL:
  https://stacks.cdc.gov/view/cdc/76951/cdc_76951_DS1.pdf
• File Type:
  [PDF - 602.84 KB ]