Short Duration Filgrastim (G-CSF) Therapy (2–4 Days) Is Adequate To Maintain Dose Intensity in Hodgkin’s Lymphoma Patients Treated with Adriamycin, Bleomycin, Vinblastine and Dacarbazine (ABVD).

Maintaining dose intensity in Hodgkin’s Lymphoma (HL) correlates with an improved outcome in patients treated with combination chemotherapy. Filgrastim is commonly used as secondary prophylaxis for neutropenia to avoid dose delays and dose reductions. Results from a retrospective review at the Mayo Clinic (

The electronic and/or paper charts of twenty-one adult patients with HL receiving ABVD at KCCC between January 2002 and May 2005 were reviewed. All patients completed at least 2 cycles of ABVD, with a median of 6 (range 2–8) cycles per patient. Of the 21 patients evaluated, 18 required administration of filgrastim as secondary prophylaxis. The precipitating factor requiring administration of filgrastim was a low ANC, which resulted in treatment being held or delayed in all patients. The filgrastim dosing regimen utilized consisted of a median of 3 doses (range 2–4) given days 6–10 post ABVD treatment. The chart review included 21 patients who received a total of 213 treatments with ABVD. Of these treatments, 78 were not preceded by filgrastim, while 135 included filgrastim. When filgrastim was not given, a subsequent dose delay occurred in 16 instances (20.5%) and dose reduction occurred in one (1.33%) instance. Of the 135 ABVD treatments with filgrastim prior to treatment, a subsequent dose delay occurred only once (0.74%) and there were five (3.7%) dose reductions. Filgrastim was dosed at 5 mcg/kg, rounded to the nearest vial size. Five patients received 300 mcg, while the remaining 13 were dosed at 480 mcg. Using this shorter dosing regimen, there is a potential cost savings of $2420 per treatment when compared to 10 doses of filgrastim. Similarly, when compared to pegfilgrastim, there is a potential cost savings of $2470 per treatment.

In conclusion, using 2–4 doses of filgrastim is a cost effective method that allows patients who are receiving ABVD to sustain dose intensity. This shortened course of filgrastim may also decrease the risk of lung toxicity. These results identify a valuable approach to potentially improve outcomes in patients with Hodgkin’s lymphoma.