Use of Granix (tbo-filgrastim) in Lymphoma Patients Receiving Chemotherapy
Yes, lymphoma patients on chemotherapy can receive Granix (tbo-filgrastim) to reduce the duration of severe neutropenia and prevent febrile neutropenia. 1
Rationale for G-CSF Use in Lymphoma Patients
- Granulocyte colony-stimulating factors (G-CSFs) like tbo-filgrastim are recommended for patients receiving chemotherapy regimens with ≥20% risk of developing febrile neutropenia (FN) 2
- G-CSFs significantly reduce the incidence, duration, and severity of chemotherapy-induced neutropenia (CIN) and febrile neutropenia (FN) 2
- Lymphoma patients, particularly those receiving R-CHOP chemotherapy, have a high baseline risk of febrile neutropenia (approximately 20.4% after first cycle) 3
- Prophylactic use of G-CSFs can prevent hospitalization, reduce antibiotic use, and maintain chemotherapy dose intensity 2
Specific Recommendations for Granix (tbo-filgrastim)
- Tbo-filgrastim is FDA-approved for reducing the duration of severe neutropenia in patients with non-myeloid malignancies (including lymphoma) receiving myelosuppressive chemotherapy 1
- The NCCN guidelines specifically include tbo-filgrastim as a category 1 recommendation for prevention of febrile neutropenia, equivalent to filgrastim and pegfilgrastim 2
- ASCO guidelines explicitly state that pegfilgrastim, filgrastim, tbo-filgrastim, and filgrastim-sndz can all be used for prevention of treatment-related FN 2
Administration Guidelines for Lymphoma Patients
- Initial dose of tbo-filgrastim: 5 mcg/kg/day administered subcutaneously 1
- Start 24-72 hours after completion of chemotherapy (not on the same day as chemotherapy) 2
- Continue until post-nadir absolute neutrophil count recovery to normal or near-normal levels 2
- Maximum duration typically 14 days per cycle 4
Risk Assessment for G-CSF Prophylaxis in Lymphoma
- Primary prophylaxis with G-CSFs is strongly recommended for patients with chemotherapy regimens associated with ≥20% risk of FN 2
- Risk factors that increase FN risk in lymphoma patients include: 3
- Age ≥65 years
- Bone marrow involvement
- Low albumin (<35 g/L)
- High relative dose intensity (≥80%)
Efficacy of G-CSFs in Lymphoma
- G-CSFs reduce the relative risk of severe neutropenia by 36-70% in patients with malignant lymphoma 5, 6
- G-CSFs reduce the relative risk of febrile neutropenia by 26% in lymphoma patients 5
- G-CSFs reduce the relative risk of infection by 26% in patients with malignant lymphoma 5
- Studies specifically with tbo-filgrastim in NHL patients showed equivalent efficacy to filgrastim in reducing duration of severe neutropenia and incidence of febrile neutropenia 7
Practical Considerations
- For weekly chemotherapy regimens, daily G-CSFs like tbo-filgrastim may be more appropriate than long-acting formulations 1
- Common adverse effects include bone pain, which can be managed with non-steroidal anti-inflammatory drugs 1
- Avoid concurrent administration of G-CSFs with chemotherapy on the same day 2
- For patients who prefer fewer injections, pegfilgrastim (single injection per cycle) may be considered as an alternative to daily tbo-filgrastim injections 8