Background:

GCSF is a hematopoietic growth factor used in patients receiving chemotherapy, which is commonly used to prevent chemotherapy-induced neutropenia and neutropenic fever. There is concern that use of GCSF can enhance proliferation of myeloid blasts. Our goal was to analyze the effect of GCSF on survival with patients with AML.

Methods:

TrinetX, a global federated research network, provides a dataset of electronic medical records from different healthcare organizations (HCOs), was utilized. Initial query was made to isolate patients with AML. The population was further divided into two groups, based on the receipt of GCSF (filgrastim, pegfilgrastim, lenograstim, eflapegrastim) within 6 months of diagnosis. Further, propensity score matching (PSM) was carried out to match age, sex, race, and severe sepsis. Descriptive analysis was used for demographic data. Kaplan Meier analysis using log-rank test was used for overall survival (OS), and Cox regression used for hazard ratio (HR).

Results:

99,756 patients were identified with AML, out of whom 21.34% (21,293) received GCSF. It was seen that patients who received GCSF were significantly younger (56.2 ± 16.3 vs. 60.5 ± 18.7, p <0.0001). Males were predominant gender in both groups and were significantly higher in receiving GCSF (54% vs. 52%, p <0.0001). Looking into Race, Caucasians (67% vs. 49%, p <0.0001) were predominant race in both groups. African Americans (8% vs. 7%, p<0.0001) and Asians (5% vs. 3%, p <0.0001) were significantly more in the GCSF group, while Unknown races were more in no GCSF group (16% vs. 37%, p <0.0001). Patients who received GCSF were found to have more severe sepsis with or without shock (11% vs. 2%, p<0.0001). Median follow-up was 549 days and 202 days for patients in the GCSF group and not in the GCSF group, respectively. Relapse of AML was significantly more in the GCSF group (25.41% (4,512) vs. 7.26% (5,107), p <0.0001; OR - 4.35 (4.162,4.547)). 47.14% patients died in GCSF group compared to 32.07% in non-GCSF group (p<0.0001). Kaplan Meier curve showed significant separation of curve with median OS shorter in patients who received GCSF (1,079 vs. 2,339 days, p<0.0001; Hazard Ratio - 1.132 (1.106-1.159)). After PSM, 25.50% patients who received GCSF had relapse (25.50 vs. 9.0%, p<0.0001; OR - 3.461 (3.259,3.675)) and 46.48% died (46.48% vs. 33.38%, p<0.0001; HR - 1.263 (1.224,1.304)).

Conclusion:

Our study shows real world data, where use of GCSF in patients with AML has increased risk for relapse as well as death. Overall survival was also shorter for patients who received GCSF. GCSF should be used very diligently in AML cases.

Disclosures

No relevant conflicts of interest to declare.

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2024
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