AN INVESTIGATION OF THE EFFICACY AND ECONOMICS OF POSTTRANSPLANT FILGRASTIM (G-CSF)
Harvinder Sandhu, Nick Duncan
Pharmacy Department, Queen Elizabeth Hospital, Birmingham
Harvinder Sandhu
Oncology pharmacist
Pharmacy Department
Queen Elizabeth Hospital
Edgbaston
Birmingham
B 15 2TH
Tele - 0121 627 2323
Fax - 0121 627 2324
Harvinder.Sandhu@uhb.nhs.uk
AN INVESTIGATION OF THE EFFICACY AND ECONOMICS OF POSTTRANSPLANT FILGRASTIM (G-SCF)
Harvinder Sandhu, Nick Duncan
Pharmacy Department, Queen Elizabeth Hospital, Birmingham
Introduction
Granulocyte colony-stimulating factor (G-CSF) is widely administered post peripheral
blood stem cell transplant (PBSCT) to hasten neutrophil recovery.1,2 Pegfilgrastim has
shown promise as an alternative to conventional G-CSF in this setting3,4 but is
associated with significant acquisition costs. It was decided to investigate the
effectiveness and economics of our current G-CSF policy prior to considering a
potential move to a pegfilgrastim-based schedule.
Methods
Data on filgrastim administration and neutrophil recovery were collected for all patients
who underwent autologous or allogeneic stem cell transplantion (SCT) from October
2007 – September 2008.
Results
144 patients were transplanted during the study period. 36 were excluded because they
were transferred to another hospital post transplant or did not receive post-transplant
filgrastim. Of the remaining 108 patients, 48 underwent an autologous SCT and 60 an
allogeneic SCT. Compliance with the unit policy was good with 91% of patients
starting filgrastim on day +8 (+/-24 hours) post transplant and 86% of patients stopping
filgrastim on day 2 (+/-24 hours) of neutrophils >1x109/l. Key data are presented
below.
Median daily dose of
Filgrastim (range)
Median duration of filgrastim
(range)
Median time to ANC>1x109/l
for 2/7 (range)
All patients (n=108)
4.2mcg/kg
(2.5-7.9mcg/kg)
6 days (2-15 days)
Autografts (n=48)
3.8mcg/kg
(2.5-7.7mcg/kg)
6 days (2-11 days)
Allografts (n=60)
4.4mcg/kg
(2.6-7.9)
5.5 days (2-15 days)
13 days (10-22 days)
13 days (10-16 days)
13 days (11-22 days)
It was observed that the majority of patients (82%) started filgrastim at a dose of
300mcg, irrespective of weight. However, there was no correlation between dose per
body weight of filgrastim received and time to neutrophil recovery. The average total
dose of filgrastim received was 2,172mcg, equating to a total cost5 of £495 per patient.
Discussion and Conclusions
This study demonstrated acceptable compliance with the current unit policy, an
unexpected lack of difference between recipients of autologous and allogeneic SCT
with respect to filgrastim requirements and time to neutrophil recovery, and evidence
that a dose of 300mcg/day appeared sufficient for the majority of patients. The average
cost per patient of growth factor support would suggest that pegfilgrastim may not be a
cost-effective alternative to conventional filgrastim in this setting.
References
1.
Klumpp TR et al. Granulocyte colony-stimulating factor accelerates
neutrophil engraftment following peripheral blood stem cell transplantation:
a prospective, randomized trial. J Clin Oncol 1995; 13: 1323-1327
2.
Przepiorka D et al. Controlled trial of filgrastim for acceleration of
neutrophil recovery after allogeneic blood stem cell transplantation from
human leucocyte antigen-matched related donors. Blood 2001; 97: 34-53410
3.
Staber PB et al. Fixed-dose single administration of pegfilgrastim vs daily
filgrastim in patients with haematoligical malignancies undergoing
autologous peripheral blood stem cell transplantation. Bone Marrow
Transplant 2005; 35: 889-893
4.
Ocheni S et al. Pegfilgrastim compared to lenograstim after allogeneic
peripheral stem-cell transplantation from unrelated donors. Leuk
Lymphoma. Advance Access published on March 5 2009 as doi:
10.1080/10428190902777442
5.
British National Formulary. No. 57, March 2009. British Medical
Association and Royal Pharmaceutical Society of Great Britain. London.