Lymphoma, Neutropenia
Conditions
Keywords
lymphoma, neutropenia, pegfilgrastim
Brief summary
Granulocyte colony stimulating factors (GCSFs) stimulate the level of white blood cells, specifically neutrophils. GCSF support for patients receiving chemotherapy was shown to decrease the rate of fever during low neutrophil count (neutropenia), and in some cancer types may decrease mortality. Pegfilgrastim is a pegylated form of the GCSF named filgrastim. Pegfilgrastim is used to stimulate bone marrow to produce more neutrophils to fight infection in patients undergoing chemotherapy. It has a much longer half-life than the parent filgrastim. It is removed from the body within the neutrophils. According to the American Society of Clinical Oncology 2006 guidelines pegfilgrastim should be given 24 hours after the completion of chemotherapy i.e.before neutrophil count starts to drop. Therefore it is cleared before and after neutropenia. Comparative low quality studies suggest that deferring pegfilgrastim delivery until neutrophil counts start dropping may result in improved its efficacy. This was further tested in a few small randomized controlled trials (high quality studies, considered the gold standard of studies) in different settings (including first chemotherapy for lymphoma, and solid cancer) with inconsistent results. Pegfilgrastim (given 24 hours after completion of chemotherapy) is a standard part of any salvage chemotherapy for patient with refractory or relapsed aggressive lymphoma. The investigators plan a randomized controlled trial comparing the efficacy of pegfilgrastim given 72 hours (day +3) vs. 24 hours (day +1) after completion of salvage chemotherapy in patients with refractory or relapsed aggressive lymphoma. The investigators will evaluate whether that change of pegfilgrastim schedule affects the risk of fever during neutropenia, neutrophil count, length of hospitalization, mortality, and safety.
Interventions
DRUGPegfilgrastim
Sponsors
Tel-Aviv Sourasky Medical Center
Soroka University Medical Center
Rabin Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
Adult patients (age 18 years or above) * Refractory or relapsed aggressive lymphoma, including Hodgkin's and non-Hodgkin's lymphoma * Candidate for salvage chemotherapy. Salvage chemotherapy includes one of the following regimens: Ifosfamide, etoposide, vincristine (ICE), Cisplatin, cytarabine, and dexamethasone (DHAP), Etoposide, methylprednisolone, cytarabine, cisplatin (ESHAP). Chemotherapy dose reduction will be allowed. * Chemotherapy with or without immunotherapy * Therapy in hospital or at the outpatient clinic
Exclusion criteria
* Indolent lymphoma; we will exclude patients with transformed lymphoma. * Treatment with GCSFs for the primary disease (e.g. aplastic anemia, MDS). * Uncontrolled infection * Pregnant women
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Febrile neutropenia | 30 days | Number of participants with fever and neutropenia |
| Neutrophil count <500/ mcL | day 8 to 10 | Number of participants with neutrophil count below 500 /mcL |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of febrile days | 30 days | a febrile day defined by at least one documented temperature measurement \>38ºC |
| Development of clinically documented infections (CDI), microbiologically-documented infections (MDI) and clinically-significant bloodstream infections (BSI), not present at the time of randomization | 30 days | Number of participants with CDI, MCI or BSI. CDI, MDI and BSI will be defined in accordance with the CDC surveillance definitions for healthcare-associated infections |
| Mortality | 30 days | Number of participants who died by day 30 |
| Adverse events | 30 days | ECOG common toxicity criteria grading Number of patients with an adverse event (AE). Number of patients with grade 3-4 AE |
| Hospitalization | 30 days | Number of hospitalization days of each participant (excluding days of hospitalization for chemotherapy) |
| Neutrophil count <100/ mcL | day 8 to 10 | Number of patients with neutrophil count below 100/ mcL |
Countries
Israel
Contacts
Primary ContactLiat Vidal-Fisher, MD
Outcome results
None listed