Intermittent granulocyte colony-stimulating factor for neutropenia management in patients with relapsed or refractory multiple myeloma treated with lenalidomide plus dexamethasone

• Published in: Leukemia & lymphoma Vol. 56; no. 2; pp. 407 - 414
• Main Authors: Sun, Haowei (Linda), Atenafu, Eshetu G., Yeboah, Elizabeth, Reece, Donna E., Trudel, Suzanne, Kukreti, Vishal, Masih-Khan, Esther, Winter, Andrew, Chen, Christine
• Format: Journal Article
• Language: English
• Published: United States Informa Healthcare 01.02.2015
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Dexamethasone - administration & dosage; Dexamethasone - adverse effects; Disease-Free Survival; Drug Administration Schedule; Drug Resistance, Neoplasm; Female; Granulocyte Colony-Stimulating Factor - therapeutic use; Humans; Kaplan-Meier Estimate; Lenalidomide; Male; Middle Aged; Multiple Myeloma - drug therapy; Multiple Myeloma - pathology; Neoplasm Recurrence, Local; Neutropenia - chemically induced; Neutropenia - prevention & control; Retrospective Studies; Thalidomide - administration & dosage; Thalidomide - adverse effects; Thalidomide - analogs & derivatives; Time Factors; Treatment Outcome; infections; neutropenia; granulocyte colony-stimulating factor; Relapsed or refractory multiple myeloma; lenalidomide plus dexamethasone
• ISSN: 1042-8194; 1029-2403
• DOI: 10.3109/10428194.2014.915544

Abstract Neutropenia is a major dose-limiting toxicity associated with lenalidomide in relapsed/refractory multiple myeloma (MM). The optimal dosing schedule of granulocyte colony-stimulating factor (G-CSF) is unclear. We developed an intermittent G-CSF schedule (4-6 doses per cycle) initiated upon onset of grade 3-4 neutropenia. Of 216 patients with relapsed/refractory MM treated at our center with lenalidomide/dexamethasone on an Expanded Access Program, there was a high incidence of grade 3-4 neutropenia (61%) and grade 3-4 infections (37%). Despite intermittent G-CSF use in 117 patients, recurrent grade 3-4 neutropenia was common (59%), and dose reductions were required in 40% of G-CSF recipients, most due to thrombocytopenia. G-CSF recipients had a longer duration on therapy and achieved a higher rate and depth of response. Intermittent G-CSF may be an effective approach for lenalidomide dose-preservation, which may lead to improved outcomes, although it does not prevent infections or thrombocytopenia-related dose limitations.