Comparison of filgrastim, pegfilgrastim, and lipegfilgrastim added to chemotherapy for mobilization of CD34 ⁺ cells in non-Hodgkin lymphoma patients

BACKGROUND: Data are limited on the long-acting granulocyte-colony stimulating factors (G-CSFs) pegfilgrastim (PEG) and lipegfilgrastim (LIPEG) compared with filgrastim (FIL) regarding the mobilization efficiency of CD34 ⁺ cells, graft cellular composition, and engraftment. STUDY DESIGN AND METHODS: In this prospective nonrandomized study, 36 patients with non-Hodgkin lymphoma received FIL, 67 received PEG, and 16 patients received LIPEG as a cytokine after chemotherapy. We analyzed the mobilization and collection of CD34 ⁺ cells, cellular composition of blood grafts, and hematologic recovery after auto-SCT according to the type of G-CSF used. RESULTS: Patients in the LIPEG group had fewer apheresis sessions (1 vs. 2, p = 0.021 for FIL and p = 0.111 for PEG) as well as higher median blood CD34 ⁺ cell counts at the start of the first apheresis (LIPEG 74 × 10 ⁶ /L vs. FIL 31 × 10 ⁶ /L, p = 0.084 or PEG 27 × 10 ⁶ /L, p = 0.021) and CD34 ⁺ yields of the first apheresis (FIL 5.1 × 10 ⁶ /kg vs. FIL 2.3 × 10 ⁶ /kg, p = 0.105 or PEG 1.8 × 10 ⁶ /kg, p = 0.012). Also, the costs associated with G-CSF mobilization and apheresis were lower in the LIPEG group. The graft composition was comparable except for the higher infused CD34 ⁺ cell counts in the LIPEG group. The engraftment kinetics were significantly slower in the FIL group. CONCLUSION: LIPEG appears to be more efficient compared with PEG after chemotherapy to mobilize CD34 ⁺ cells for auto-SCT demonstrated as fewer sessions of aphereses needed as well as 2.8-fold CD34 ⁺ cell yields on the first apheresis day. Early hematologic recovery was more rapid in the LIPEG group. Thus further studies on LIPEG in the mobilization setting are warranted.