Can Granix (tbo-filgrastim) be given to a patient receiving chemotherapy for B-cell lymphoma to reduce the risk of febrile neutropenia?

Use of Granix (tbo-filgrastim) for Patients Receiving Chemotherapy for B-cell Lymphoma

Yes, Granix (tbo-filgrastim) can be used for patients receiving chemotherapy for B-cell lymphoma to reduce the risk of febrile neutropenia. 1

Rationale for G-CSF Use in B-cell Lymphoma

• B-cell lymphoma chemotherapy regimens, particularly R-CHOP, are associated with a high risk of febrile neutropenia (FN), with studies showing an incidence of approximately 20.4% after the first cycle of chemotherapy 2
• Granulocyte colony-stimulating factors (G-CSFs) like tbo-filgrastim are recommended for patients receiving chemotherapy with ≥20% risk of developing FN 1
• G-CSFs significantly reduce the risk of FN, hospitalization, and potentially infection-related mortality in patients receiving myelosuppressive chemotherapy 1

Specific Recommendations for G-CSF Selection

• Tbo-filgrastim (Granix) is specifically approved for reduction in the duration of severe neutropenia in patients with non-myeloid malignancies (including B-cell lymphoma) receiving myelosuppressive anticancer drugs associated with a clinically significant incidence of FN 1
• Multiple clinical trials have demonstrated that tbo-filgrastim has similar safety and efficacy to filgrastim in patients with various cancers, including non-Hodgkin lymphoma 1
• The American Society of Clinical Oncology (ASCO) guidelines explicitly state that pegfilgrastim, filgrastim, tbo-filgrastim, and filgrastim-sndz can all be used for prevention of treatment-related FN 1

Dosing and Administration for tbo-filgrastim (Granix)

• Initial dose of 5 mcg/kg/day administered subcutaneously 1
• Start 24-72 hours after completion of chemotherapy (not on the same day as chemotherapy) 1
• Continue until post-nadir absolute neutrophil count recovery to normal or near-normal levels by laboratory standards 1
• The dose may be rounded to the nearest vial size according to institution-defined weight limits 1

Risk Assessment for G-CSF Prophylaxis

• Primary prophylaxis with G-CSFs is strongly recommended for patients with:
  • Chemotherapy regimens associated with ≥20% risk of FN 1
  • Dose-dense chemotherapy regimens when appropriate 1
  • Age ≥65 years, which is an independent risk factor for FN in lymphoma patients 2
  • Additional risk factors such as bone marrow involvement, low albumin levels, and high planned dose intensity 2

Clinical Considerations

• In a meta-analysis of patients with solid tumors or lymphoma, G-CSFs significantly reduced the risk of FN with a relative risk of 0.51 (95% CI: 0.41 to 0.62) 3
• For B-cell lymphoma specifically, biosimilar filgrastim has demonstrated clinical effectiveness and safety in real-world practice 4
• Common adverse effects of G-CSFs include bone pain, which can be managed with nonsteroidal anti-inflammatory drugs 1
• Avoid concurrent administration of G-CSFs with chemotherapy on the same day 1

Special Considerations for Lymphoma Patients

• Patients with lymphoma receiving R-CHOP or similar regimens are considered at high risk for FN and should receive G-CSF support 1, 2
• A single injection of pegfilgrastim per chemotherapy cycle provides similar neutrophil support to daily injections of filgrastim or tbo-filgrastim, but the choice between agents should be based on convenience, cost, and clinical situation 1, 5
• For patients receiving weekly chemotherapy regimens, daily G-CSFs like tbo-filgrastim may be more appropriate than long-acting formulations 1

In summary, Granix (tbo-filgrastim) is an appropriate and FDA-approved option for reducing the risk of febrile neutropenia in patients receiving chemotherapy for B-cell lymphoma, with efficacy comparable to other G-CSF formulations.