Management of Neutropenia May be Simplified for Patients with HD or NHL
According to results recently presented at the 43rd annual meeting of the American Society of Hematology, a single dose of Pegfilgrastim may be just as effective as daily doses of Neupogen® in the management of neutropenia for patients with non-Hodgkin’s Lymphoma (NHL) or Hodgkin’s disease (HD) undergoing chemotherapy.
Hodgkin’s disease and NHL are both cancers of the lymph system, which is part of the immune (infection fighting) system that includes blood vessels, bone marrow, lymph nodes and lymph vessels that are present throughout the body. It also includes organs such as the spleen, thymus and tonsils. Hodgkin’s disease and NHL differ in that different cells of the immune system turn cancerous in either disease. These cancers are characterized by the presence of the uncontrollable growth and division of their respective immune cells, which ultimately crowd lymph tissue, suppressing the formation and function of other cells normally found in this tissue.
Chemotherapy is the standard treatment for both HD and NHL. Chemotherapy not only destroys cancer cells but also normal cells that grow rapidly such as blood cells forming in the bone marrow, cells in the hair follicles, or cells in the mouth and intestines. Neutropenia occurs when white blood cells are destroyed by treatment. Since white blood cells are critical to preventing and fighting bacterial, viral and fungal infections, patients with neutropenia are at a high risk for developing infection and may require treatment dose reduction or delay. Neupogen® is an agent that is approved for the treatment of neutropenia that stimulates the production of white blood cells.
In a multi-center study researchers recently conducted a clinical trial evaluating the efficacy of single dose Pegfilgrastim versus daily dose Neupogen® for the management of neutropenia in patients with HD and NHL. Pegfilgrastim is a long-acting form of Neupogen®, meaning that one dose of Pegfilgrastim will remain active for a longer period of time than Neupogen®. In this clinical trial, 60 patients receiving ESHAP (etoposide, methylprednisolone, cisplatin, and cytarabine) chemotherapy were split into two groups either receiving one subcutaneous injection of Pegfilgrastim or daily injections of Neupogen® between each cycle of chemotherapy. Both groups had similar ages, stages of disease and had received prior chemotherapy as well as radiation therapy. For patient receiving Neupogen®, an average of 11 injections were given and the average duration of severe neutropenia was 2.4 days. The average duration of severe neutropenia for patients receiving Pegfilgrastim was 2.8 days. The incidence of grade 4 neutropenia was 68% for patients receiving Neupogen® and 69% for patients receiving Pegfilgrastim. No chemotherapy delays or dose reductions were necessary in either group. Furthermore, no significant differences in neutropenia incidence, neutropenia duration or severity of bone pain were noted between the groups.
These results are encouraging for potentially simplifying the management of neutropenia to a single subcutaneous injection for patients with NHL or HD undergoing chemotherapy. Patients with NHL or HD may wish to speak with their physician about the risks and benefits of participating in a clinical trial further evaluating the efficacy of Pegfilgrastim for the management of neutropenia and other novel approaches. Two sources of information regarding ongoing clinical trials include comprehensive, easy-to-use listing services provided by the National Cancer Institute (cancer.gov) and www.eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients. (Proceedings from the 43rdannual meeting of the American Society of Hematology, abstract # 3322, Orlando, Florida, December 11-14, 2001)
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