From the Guidelines
G-CSF is not routinely required for patients receiving bendamustine and rituximab, but may be considered for high-risk patients with factors such as age, comorbidities, or previous chemotherapy exposure. The use of G-CSF in patients receiving bendamustine and rituximab should be individualized based on patient characteristics, as the risk of neutropenia can be significant, with rates ranging from 20-40% 1. Key factors to consider when deciding on G-CSF use include:
- Age, with patients over 65 years being at higher risk
- Comorbidities, which can increase the risk of infectious complications
- Previous chemotherapy exposure, which can impact bone marrow reserve
- Bone marrow involvement, which can affect blood cell production
- Baseline blood counts, which can indicate a higher risk of neutropenia According to the study by Tedeschi et al, as referenced in 1, the major toxicity of bendamustine and rituximab was grade 3 to 4 neutropenia, which occurred in 13% of patients, highlighting the need for careful consideration of G-CSF use in high-risk patients. If G-CSF is deemed necessary, it can be administered as filgrastim (Neupogen) 5 μg/kg daily or pegfilgrastim (Neulasta) 6 mg once per cycle, starting 24-72 hours after completing chemotherapy, to help prevent serious infectious complications.
From the Research
GCSF Use in Bendamustine and Rituximab Treatment
- The use of granulocyte-colony stimulating factors (G-CSF) in patients receiving bendamustine and rituximab treatment has been evaluated in several studies 2, 3, 4, 5.
- A study published in 2017 found that primary prophylaxis with pegfilgrastim significantly reduced the incidence of febrile neutropenia (FN) and chemotherapy disruptions in patients with indolent non-Hodgkin lymphoma treated with bendamustine and rituximab 2.
- Another study published in 2021 found that primary and secondary prophylaxis with G-CSF had similar outcomes in terms of FN and grade 3 or 4 neutropenia, but primary prophylaxis was associated with fewer chemotherapy dose delays 3.
- The use of G-CSF in patients receiving first-line chemotherapy for non-Hodgkin's lymphoma (NHL) was assessed in a retrospective study, which found that only 29% of patients received primary prophylaxis, while two-thirds received suboptimal G-CSF use 4.
- A real-life study published in 2020 found that the use of G-CSF for FN prophylaxis was recommended, but there may be a group of patients who are inadequately or unnecessarily treated, highlighting the need for regular risk assessment using the Patient Risk Score (PRS) 5.
Risk Assessment and G-CSF Use
- The risk of febrile neutropenia (FN) should be assessed in patients receiving chemotherapy, and G-CSF use should be guided by this assessment 6, 5.
- The Patient Risk Score (PRS) can be used to assess the risk of FN and guide G-CSF use 5.
- Regular risk assessment and monitoring of G-CSF use can help optimize treatment outcomes and minimize adverse effects 5.