Paul, M., Ram, R., Kugler, E., Farbman, L., Peck, A., Leibovici, L., . . . Raanani, P. (2014). Subcutaneous versus intravenous granulocyte colony stimulating factor for the treatment of neutropenia in hospitalized hemato-oncological patients: Randomized controlled trial. American Journal of Hematology, 89, 243–248.
To examine the effectiveness of intravenous (IV) versus subcutaneous (SC) granulocyte colony-stimulating factor (G-CSF) as related to time to neutropenia resolution and secondarily to assess comparative rates of infection, adverse effects, and patient satisfaction
Randomized, controlled, open-label trial with a 1:1 randomization to SC versus IV filgrastim. Patients were given either IV or SC filgrastim on a prescribed day (day 7 of chemotherapy for patients with acute myeloid leukemia [AML], day 2 after completion of chemotherapy for lymphoma and myeloma, and the day after infusion for patients undergoing hematopoietic stem cell transplantation [HSCT]). On the subsequent chemotherapy course (at least 30 days later), patients were crossed over to the alternative study arm.
Randomized, controlled, open-label trial
Time to neutrophil resolution was longer with an IV bolus G-CSF compared to SC G-CSF with an overall mean difference of 2.5 days. There were no differences in clinical outcomes, including infection rates or adverse events observed.
The trial was not powered to examine possible serious complications of SC G-CSF administration and was stopped prematurely due to the observed results.
Findings support the continued use of SC G-CSF for limiting the duration of neutropenia. Education about the use of G-CSF in the prevention of neutropenia and managing related side effects is important.