Is Daily Lenograstim From Day +7 Of Autologous Peripheral Blood Stem Cell Transplantation (APBSCT) Is As Effective As Pegfilgrastim In Patients With Myeloma?
Authors: Bailiff Ben , Phillips Neil , Murthy Vidhya , Bratby Lynn , Holder Kathy , Kishore Bhuvan , Nikolousis E , Lovell R , Pratt Guy , Ewing Joanne , Paneesha Shankaranarayana 
Published: October 2019

Abstract
High dose melphalan conditioned APBSCT after induction therapy is thestandard of carefor patients with myeloma with good performance status. Busy haematology units are in the lookout for safe and effective strategies to hasten neutrophil engraftment, decrease inpatient stay and ease financial burden. Growth factors have been helpful in this regard. We describe our experience with the use of different growth factors in patients with myeloma undergoing APBSCT.

Aims of the study
To identify whether once daily lenograstimfrom day + 7 following APBSCT is as efficacious as one dose of pegfilgrastim on day +1with regards to neutrophil engraftment, inpatient stay, days of antibiotic use and outcomes as compared no G-CSF use.

Materials and Methods
Patients had induction treatment followed by autologous PBSC mobilisation with G-CSF alone or by cyclophosphamide (3g/m2) + G-CSF schedule. APBSCT with high dose melphalan (140 or 200 mg/ m2) conditioning was carried out as per standard indications and the day of stem cell re-infusion was termed day 0. Statistical analysis was carried out using GraphPad Prism 4 and IBM SPSS 19 for Windows. Our retrospective study included 112 patients (71male&41 female) with a median age at transplantation of 61 years (range 38-72) with myeloma betweenJanuary2006 and December 2012. 35%patients did not receive any G-CSF, 19% received pegfilgrastim and46% received lenograstim.58 % patients had IgG, 21 % IgA, 17 % light chain and 4 % had non-secretory myeloma. At transplant 7% patients were in complete remission, 20% in partial remission and 73% in very good partial remission.

Results
Median time for neutrophil engraftment was 14, 12 and 13 days in the no G-CSF, peg-filgrastim and lenograstim respectively. Median inpatient stay was 18, 16 and 16 days in the no G-CSF, peg-filgrastim and lenograstim respectively. Median days of broad spectrum intravenous antibiotic use were 6, 5 and 5 days in the no G-CSF, peg-filgrastim and lenograstim respectively. Median dose of stem cells infused was 3.1, 2.7 and 2.5 CD 34 + cells per kg body weight in the no G-CSF, peg-filgrastim and lenograstim respectively.There was no difference in the overall survival (Log Rank test; p value: 0.844) or progression free survival (Log Rank test; p value: 0.155) between the three cohorts.

Summary
Results of retrospective analysis suggests that the use of daily lenograstim from day +7 is an effective strategy as day + 1 peg-filgrastim in patients with myeloma undergoing APBSCTin reducing the time to neutrophil engraftment, duration of inpatient stay and antibiotic useand superior to no G-CSF use. Our data confirms daily lenograstim from day +7 is a cost effective alternative strategy to pegfilgrastimmaking use of use of lenograstim post autologous stem cell transplantation as a standard practice.

Disclosures:
No relevant conflicts of interest to declare.