From the FDA Drug Label
NEUPOGEN is indicated to ... Reduce the duration of neutropenia and neutropenia-related clinical sequelae‚ e.g.‚ febrile neutropenia, in patients with nonmyeloid malignancies undergoing myeloablative chemotherapy followed by bone marrow transplantation (BMT) The recommended dosage of NEUPOGEN following bone marrow transplantation (BMT) is 10 mcg/kg/day given as an intravenous infusion no longer than 24 hours.
Filgrastim decreases the time of engraftment in Acute Myeloid Leukemia (AML) transplant by reducing the duration of neutropenia. The recommended dosage for this indication is 10 mcg/kg/day given as an intravenous infusion no longer than 24 hours, starting at least 24 hours after cytotoxic chemotherapy and at least 24 hours after bone marrow infusion 1.
From the Research
Granulocyte colony-stimulating factor (G-CSF) is the primary treatment that decreases engraftment time in acute myeloid leukemia (AML) transplants. Typically, filgrastim (Neupogen) is administered at a dose of 5-10 μg/kg/day subcutaneously, starting from day +5 or +7 after stem cell infusion and continuing until absolute neutrophil count exceeds 1,500/μL for three consecutive days. Pegfilgrastim (Neulasta), a longer-acting form, can be given as a single 6 mg dose instead. G-CSF works by stimulating the proliferation and differentiation of neutrophil precursors, accelerating neutrophil recovery by approximately 3-5 days compared to no growth factor support, as shown in a study comparing filgrastim XM02 (Tevagrastim) and lenograstim 2. This faster engraftment reduces the duration of neutropenia, decreasing the risk of life-threatening infections during this vulnerable period. Some transplant centers also use plerixafor in combination with G-CSF for mobilization before transplant, which can improve stem cell collection quality and potentially contribute to faster engraftment. The choice between G-CSF formulations should consider patient-specific factors including transplant protocol, comorbidities, and cost considerations.
Key points to consider:
- G-CSF administration significantly shortens the neutropenic phase, as demonstrated in a study on the use of G-CSF after auto-SCT for AML 3.
- The use of G-CSF after auto-SCT is not associated with increased risk of relapse, as shown in a report from the Acute Leukemia Working Party of the EBMT 3.
- Filgrastim XM02 and lenograstim have comparable efficacy in shortening the period of neutropenia after cytoreduction and autologous stem cell transplantation, with a favorable cost effect for filgrastim XM02 2.
- GM-CSF has been investigated as an alternative to G-CSF, but its use is not as well established for reducing engraftment time in AML transplants, as seen in studies from 1993 and 1995 4, 5.
Overall, G-CSF is the recommended treatment for decreasing engraftment time in AML transplants, with the choice of formulation depending on individual patient factors and transplant protocol.