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Once-per-cycle pegfilgrastim versus daily filgrastim in pediatric patients with Ewing sarcoma
Gerald Wendelin1, Herwig Lackner, Wolfgang Schwinger
1Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria. wendeling@utanet.at
Insights
Pegfilgrastim, a long-acting granulocyte colony-stimulating factor, effectively reduces severe neutropenia in pediatric cancer patients, similar to daily filgrastim. This allows for a significant reduction in injections, improving supportive care.
Area of Science:
- Oncology
- Pharmacology
- Pediatric Medicine
Background:
- Cytotoxic chemotherapy often causes severe neutropenia, increasing infection risk.
- Filgrastim (recombinant human granulocyte colony-stimulating factor) is used to mitigate neutropenia but requires daily injections due to its short half-life.
- Pegfilgrastim, a pegylated form of filgrastim, offers prolonged action and has demonstrated efficacy in adults.
Purpose of the Study:
- To evaluate the efficacy and safety of pegfilgrastim in pediatric patients undergoing chemotherapy for Ewing sarcoma.
- To compare the duration of severe neutropenia and incidence of febrile neutropenia between pegfilgrastim and filgrastim treatments.
- To assess the feasibility of reducing injection frequency with pegfilgrastim in pediatric oncology.
Main Methods:
- A study involving five pediatric patients with Ewing sarcoma.
- Patients were alternately treated with pegfilgrastim (100 microg/kg single dose) or filgrastim (10 microg/kg daily dose) across 58 chemotherapy cycles.
- Outcomes measured included duration of severe neutropenia and incidence of febrile neutropenia.
Main Results:
- Pegfilgrastim was well-tolerated in pediatric patients.
- The duration of severe neutropenia was comparable between pegfilgrastim and filgrastim treatment groups.
- The incidence of febrile neutropenia was similar for both treatment regimens.
- Pegfilgrastim administration reduced the number of injections to one per cycle.
Conclusions:
- Pegfilgrastim is an effective and well-tolerated alternative to daily filgrastim for managing chemotherapy-induced neutropenia in pediatric patients with Ewing sarcoma.
- The use of pegfilgrastim simplifies supportive care by reducing the frequency of injections.
- Further research may support broader adoption of pegfilgrastim in pediatric oncology settings.
Abstract:
The use of the recombinant human granulocyte colony-stimulating factor filgrastim to shorten the duration of severe neutropenia after cytotoxic chemotherapy has become an integral part of supportive care. However, due to its short serum half-life, filgrastim must be injected daily. Pegfilgrastim, a new long-lasting form of filgrastim administrated once per cycle, has been shown in adults to be as effective in reducing the duration of severe neutropenia as daily filgrastim. The aim of this study was to evaluate the effects of pegfilgrastim in pediatric patients. Five children with Ewing sarcoma were alternately treated with a single 100 microg/kg pegfilgrastim dose or daily doses of 10 microg/kg Filgrastim after a total number of 58 chemotherapy cycles. Pegfilgrastim was well tolerated. The duration of severe neutropenia and the incidence of febrile neutropenia after pegfilgrastim and filgrastim were comparable. By using pegfilgrastim, the number of subcutaneous injections could be reduced to one single injection per cycle.