Meta-Analysis of Same-Day Pegfilgrastim Administration Stratified by Myelotoxic Febrile Neutropenia Risk and Tumor Type
Neda Alrawashdh,(1,2) PhD, PharmD, Ali McBride,(3) PharmD, MS, BCPS, Mok Oh,(1) PhD, PharmD, Nimer Alkhatib,(1) PhD, PharmD, Christopher Lee,(4) PhD, RN, FAHA, FAAN, FHFSA, Jennifer Martin,(5) MA, Karen MacDonald,(6) PhD, RN, and Ivo Abraham,(1,3,6) PhD, RN
From (1)Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, Arizona; (2)Department of Clinical Translational Sciences, College of Medicine, University of Arizona, Tucson, Arizona; (3)Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona; (4)Connell School of Nursing, Boston College, Boston, Massachusetts; (5)Arizona Health Sciences Library, University of Arizona, Tucson, Arizona; (6)Matrix45, Tucson, Arizona
Authors’ disclosures of conflicts of interest are found at the end of this article.
Correspondence to: Ivo Abraham, PhD, RN,
Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, 1295 N Martin Avenue, Tucson, AZ 85721.
J Adv Pract Oncol 2022;13(8):796–811 |
© 2022 Harborside™
Background: Pegfilgrastim is recommended to be administered at least 24 hours following the completion of chemotherapy, yet some clinicians use a same-day administration protocol. In this meta-analysis, we compared the incidence of chemotherapy-induced (febrile) neutropenia (CIN/FN) as well as CIN/FN-related chemotherapy disruptions in cancer patients provided with pegfilgrastim same-day vs. next-day. Methods: Six databases were searched for comparative studies of same-day vs. next-day pegfilgrastim administration. Fixed or random-effects meta-analyses were conducted to estimate pooled odds ratios (ORs) and 95% confidence intervals (CIs). Results: Thirteen studies were included in this meta-analysis. The FN OR for same-day vs. next-day administration was 1.48 (95% CI = 1.06–2.08) across all cycles, attributable mainly to studies of high FN risk (OR = 2.46, 95% CI = 1.04–5.83) vs. intermediate FN risk regimens (OR = 1.41, 95% CI = 0.95–2.10), and breast cancer (OR = 3.15, 95% CI = 1.24–8.01) vs. non-Hodgkin lymphoma (NHL; OR = 1.48, 95% CI = 0.98–2.23) and gynecologic cancers (OR = 0.64, 95% CI = 0.11–3.85). Where available, ORs for first cycle of chemotherapy, grades 3 and/or 4 CIN, and chemotherapy dose delays or reductions were in line with these findings. Conclusion: In this independent study, same-day pegfilgrastim administration may or may not increase the likelihood of FN, grades 3 and/or 4 CIN, and chemotherapy dose reductions or delays; and this may be a function of the myelotoxicity of the regimens (elevated in high-risk but not intermediate-risk regimens) and tumor type (elevated in breast but not in NHL or gynecologic cancers). With due caution, same-day pegfilgrastim administration may be safe and beneficial in intermediate-risk regimens and selected tumor types.
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