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Master Thesis

Pegfilgrastim associé à la chimiothérapie pour la mobilisation des cellules souches hématopoïétiques périphériques dans le cadre des lymphomes : étude rétrospective comparative en Aquitaine de 2006 à 2018

Abstract : Introduction: high dose chemotherapy followed by autologous hemapoietic stem cell transplantation (ASCT) is widely used for the treatment of lymphomas. The mobilization of peripheral hematopoietic stem cell (PBSC) with Filgrastim or Lenograstim following the chemotherapy course has become a standard. In Aquitaine, we have decided to use Pegfilgrastim both to prevent the chemotherapy-induced neutropenia and to stimulate the bone marrow for harvesting PBSC. Here we report our experience with Pegfilgrastim in this setting and retrospectively compare the results using either Pegfilgrastim or standard growth factors (G-CSF). Materials and Methods: from 2006 to 2018, 232 patients received 6 mg of Pegfilgrastim and 158 patients received 5 to 10 μg/kg of Filgrastim or Lenograstim (standard) after a disease specific chemotherapy for treatment of Hodgkin and non-Hodgkin lymphoma. The main endpoint of this study was to evaluate the ability of Pegfilgrastim to achieve a graft > 2x 106 CD34/kg. We also studied the grafts composition in CD34 + cells, the viability and the recovery of the cells through the cryopreservation process and the hematopoietic engraftment after ASCT comparing Pegfilgrastim to standard G-CSF. Results: mobilization success rate were similar (90,9 % for Pegfilgrastim and 91,7% for standard mobilization respectively, p =0,7). The CD34+ cells yield was higher with standard mobilization (5,175 versus 6,3 x 106 CD34/kg respectively, p=0,008). The CD34+ recovery and viability after thawing were higher in the Pegfilgrastim group. Hence the number of infused viable CD34+ cells was similar in the two groups. Engraftment features after ASCT were also similar in the two groups. There was no additional toxicity with Pegfilgrastim. Considering all the different economic aspects of the use of Pegfilgrastim, we found that the cost is lower compared to standard G-CSF (4525,7 € versus 5479,5 €, p <0,001). Conclusion: mobilization with Pegfilgrastim is safe and as effective as standard G-CSF for PBSC mobilization after chemotherapy in patients with Hodgkin and non-Hodgkin Lymphoma. There is no additional cost impact on the health-care system.
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Baptiste Pérard. Pegfilgrastim associé à la chimiothérapie pour la mobilisation des cellules souches hématopoïétiques périphériques dans le cadre des lymphomes : étude rétrospective comparative en Aquitaine de 2006 à 2018. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02495887⟩

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