From the Guidelines
Filgrastim is effective in treating neutropenia in myelodysplastic syndrome (MDS), particularly when used in combination with erythropoietin for patients with low endogenous serum erythropoietin levels and ringed sideroblasts, as evidenced by the most recent guideline from 2021 1.
Key Points
- Filgrastim works by stimulating the production of neutrophils, helping to reduce infection risk in MDS patients with low neutrophil counts.
- The typical dose ranges from 1 to 2 mcg/kg subcutaneously daily or 1 to 3 times a week, as suggested by the 2013 guideline 1.
- Treatment duration varies - some patients require ongoing therapy while others may use it intermittently during severe neutropenic episodes.
- Filgrastim is particularly beneficial for MDS patients with severe neutropenia (ANC <500/mm³) who have recurrent infections.
- However, it doesn't address the underlying bone marrow dysfunction in MDS or improve other cytopenias like anemia or thrombocytopenia.
- There's also a theoretical concern that growth factors might stimulate leukemic cell growth in some MDS patients, particularly those with excess blasts.
- Response to filgrastim should be monitored with regular complete blood counts, and treatment should be temporarily stopped if neutrophil counts exceed 10,000/mm³ to avoid potential complications from excessive white blood cell production.
Considerations
- The use of filgrastim in MDS patients should be based on individual patient needs and risk factors, as outlined in the 2021 guideline 1.
- Patients with low endogenous serum erythropoietin levels and ringed sideroblasts may benefit from the combination of filgrastim and erythropoietin.
- The dose and duration of filgrastim treatment should be adjusted based on neutrophil response and patient tolerance.
- Regular monitoring of blood counts and adjustment of treatment as needed is crucial to minimize the risk of complications and maximize the benefits of filgrastim treatment in MDS patients.
From the Research
Filgrastim in Myelodysplastic Syndrome (MDS)
- Filgrastim, a Granulocyte-Colony Stimulating Factor (G-CSF), is used to treat hematopoietic failure in patients with MDS 2.
- The use of G-CSF, including filgrastim, has been associated with an increased risk of developing myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) in older patients with non-Hodgkin lymphoma 3.
- A study found that the receipt of filgrastim was associated with a higher risk of MDS/AML, particularly with increasing doses 3.
- However, the use of filgrastim in MDS is not well-established, and its efficacy in this setting is not clearly defined.
Treatment Options for MDS
- Supportive care measures, including hematopoietic growth factors such as filgrastim, are commonly used to manage MDS 2.
- Other treatment options for MDS include erythropoiesis-stimulating agents, hypomethylating agents, and lenalidomide 2, 4, 5.
- Thrombopoiesis-stimulating agents, such as eltrombopag and romiplostim, have also been investigated for the treatment of thrombocytopenia in MDS 6.
Efficacy and Safety of Filgrastim in MDS
- The efficacy and safety of filgrastim in MDS are not well-established, and further studies are needed to determine its role in the treatment of this condition.
- The use of filgrastim in MDS may be associated with an increased risk of MDS/AML, and patients should be closely monitored for signs of disease progression 3.