Incidence of myelodysplastic syndromes in patients receiving concurrent myelosuppressive chemotherapy and pegfilgrastim

Abstract

Background: The World Health Organization classifies myelodysplastic syndromes (MDS) as a group of hematologic malignancies where at least one myeloid lineage contains ≥10% cells with myelodysplasia. Therapy-related MDS (t-MDS) may result from treatment with myelosuppressive chemotherapy and/or radiation. Myeloid growth factors, such as pegfilgrastim, have also been investigated as a possible risk factor for development of t-MDS. National guidelines and myeloid growth factor prescribing information recommend administering myeloid growth factors after a minimum of 24 h following myelosuppressive chemotherapy. Some evidence suggests that administering myeloid growth factors and myelosuppressive chemotherapy concurrently may increase the risk of developing t-MDS.

Objective: To evaluate the incidence of t-MDS in patients who received pegfilgrastim and chemotherapy on the same day compared to patients receiving pegfilgrastim at least 1 day following completion of their chemotherapy.

Methods: A retrospective chart review was performed to identify all patients who received myelosuppressive chemotherapy and pegfilgrastim on the same day between January 2003 and December 2007. Any initial diagnosis of t-MDS was clinically confirmed.

Results: A total of 227 patients received myelosuppressive chemotherapy and pegfilgrastim on the same day. Median time to follow-up was 3.47 years (IQR 1.15). Two patients had a confirmed diagnosis of t-MDS. The incidence of t-MDS in patients receiving concurrent myelosuppressive chemotherapy and pegfilgrastim in our study population is 0.88%.

Conclusion: Administering pegfilgrastim at least 1 day after myelosuppressive chemotherapy may help reduce the risk of t-MDS, but more studies with longer follow-up are needed to confirm this finding.