January 1, 2000Journal of Clinical Oncology
Randomized Trial of Filgrastim, Sargramostim, or Sequential Sargramostim and Filgrastim After Myelosuppressive Chemotherapy for the Harvesting of Peripheral-Blood Stem Cells
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Discussion
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Implication
Randomized trial reveals filgrastim enhances CD34+ cell yield and lowers complications after chemotherapy compared to sargramostim, indicating filgrastim is superior for stem cell harvesting.
Key Points
- To compare CD34+ cell yields and patient morbidity among regimens using filgrastim, sargramostim, or sequential sargramostim and filgrastim following myelosuppressive mobilization chemotherapy.
- Randomized trial of 156 patients allocated to receive filgrastim (n = 51), sargramostim (n = 52), or sequential sargramostim for 5 days followed by filgrastim (n = 53).
- Mobilization chemotherapy consisted of cyclophosphamide and etoposide (n = 75) or paclitaxel and cyclophosphamide (n = 81).
- Patients receiving filgrastim yielded more CD34+ cells (median 7.1 vs 2.0 × 10^6/kg/apheresis; P = .0001) and a higher fraction achieved ≥5 × 10^6 cells/kg (88% vs 53%; P = .001) with fewer aphereses (median 2 vs 3; P = .002) than those receiving sargramostim.
- Filgrastim led to faster recovery of absolute neutrophil count ≥0.5 × 10^9/L (median 11 vs 14 days; P = .0001), fewer fevers (18% vs 52%; P = .001), fewer hospitalizations (20% vs 42%; P = .013), and less IV antibiotic therapy (24% vs 69%; P = .001) compared with sargramostim.
- Following subsequent high-dose chemotherapy, patients mobilized with filgrastim or the sequential regimen experienced faster platelet recovery (P = .015) and required fewer platelet transfusions (P = .001) than those mobilized with sargramostim.
Cite This Study
Weaver et al. (2000) studied this question.