Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Incidence of Febrile Neutropenia and Time to Count Recovery in Patients with Acute Myeloid Leukaemia receiving Pegylated G-CSF following High-Dose Cytarabine (HiDAC) Consolidation (#245)

Madeleine Washbourne 1 , Lynn Peng 2 , Michael Whordley 1 , Elizabeth Luo 1
  1. Princess Alexandra Hospital, Brisbane, Queensland, Australia
  2. Queensland University of Technology, Brisbane, Queensland, Australia

Aims:
To investigate the incidence of febrile neutropenia (FN) and time to count recovery (TTCR) between varying pegylated granulocyte-colony stimulating factor (G-CSF) in patients with Acute Myeloid Leukaemia (AML) during High-Dose Cytarabine (HiDAC) consolidation chemotherapy. 

Methods
A retrospective observational audit at a single tertiary center was conducted between 01/01/2016 -31/12/2022 to capture prescribing practice of pegfilgrastim and lipegfilgrastim. Patients with a diagnosis of AML receiving non-trial HiDAC chemotherapy with pegylated G-CSF support were included. Data collection parameters included prior chemotherapy exposure, cytogenetics, G-CSF choice, TTCR (absolute neutrophil count [ANC] >0.5 and >1), and length of admission. Data was extracted using digital patient records and analysed through Microsoft Excel.  

Results:
A total of 60 patients were identified with 7 patients in the pegfilgrastim group and 53 patients in the lipegfilgrastim group. Following this, 7 patients in the lipegfilgrastim group were randomly extracted to compare against the pegfilgrastim group. The incidence of FN for pegfilgrastim and lipegfilgrastim in HiDAC cycles was 39.1% and 52.4% respectively. Median TTCR to ANC >0.5 and >1 was 19 and 23 days in the pegfilgrastim group with lipegfilgrastim demonstrating 20 and 23 days respectively. Infection risk was comparable for both pegfilgrastim and lipegfilgrastim at ~21%. The calculated length of admission was 8 days for both groups. Higher HiDAC doses correlated with high rates of FN in the lipegfilgrastim group. Despite differences between some results, nil statistical significance was reached. 

Conclusion:
Pegfilgrastim had fewer rates of FN and a shorter TTCR compared to lipegfilgrastim in patients with AML during HiDAC consolidation, however statistical significance was not achieved. Pegfilgrastim appears as effective as lipegfilgrastim from this audit despite what the theoretical difference in drug pharmacokinetic properties would infer. Therefore, a greater sample size is required for more robust data.