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Myelodysplastic Syndrome and Acute Myeloid Leukemia Following Use of Granulocyte Colony-Stimulating Factors in Older Non-Hodgkin Lymphoma Patients
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December 12 2018
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Source: Cancer. 125(7):1143-1154
[PDF-602.84 KB]
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Alternative Title:Cancer
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Personal Author:
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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.
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Pubmed ID:30548485
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Pubmed Central ID:PMC6420387
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