Intermittent granulocyte colony-stimulating factor for neutropenia management in patients with relapsed or refractory multiple myeloma treated with lenalidomide plus dexamethasone. Issue 2 (February 2015)

• Record Type: Journal Article
• Authors: Sun, Haowei (Linda); Atenafu, Eshetu G.; Yeboah, Elizabeth; Reece, Donna E.; Trudel, Suzanne; Kukreti, Vishal; Masih-Khan, Esther; Winter, Andrew; Chen, Christine
• Is Part Of: Leukemia & lymphoma. Volume 56:Issue 2(2015:Feb.)
• Page Start: 407
• Page End: 414
• Publication Date: 2015-02
• Subjects: Leukemia -- Periodicals; Lymphomas -- Periodicals; 616.99419
• DOI: 10.3109/10428194.2014.915544
• Languages: English
• ISSNs: 1042-8194

Abstract

<abstract> <title>Abstract</title> <p>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.</p> </abstract>