The impact of G-CSF on brentuximab vedotin plus chemotherapy in treating newly diagnosed advanced Hodgkin lymphoma

The study evaluated the impact of granulocyte-colony stimulating factor (G-CSF; Neupogen) on the outcomes of brentuximab-vedotin (BV; Adcetris) plus chemotherapy in newly diagnosed patients with stage-III/IV Hodgkin lymphoma (HL). The authors found that G-CSF improved the safety and efficacy outcomes of the combination therapy in such patients.

BV and ABVD chemotherapy that includes doxorubicin (Adriamycin), bleomycin (Blenoxane), vinblastine (Velban), dacarbazine (DTIC) or BV plus AVD (ABVD without bleomycin) are frontline therapies for patients with stage-III/IV HL.

G-CSF is a drug that activates the bone marrow to produce neutrophils, which are disease-fighting blood cells. Febrile neutropenia (FN) happens due to a lack of neutrophils, along with fever and infection. This is a common and serious side effect of treatments for HL.

Prior studies showed that treatment with G-CSF reduced FN in these patients. However, the direct impact of G-CSF on A+AVD’s outcomes in patients with advanced HL are unknown.

The study included 662 adult patients with stage-III/IV HL. They were undergoing A+AVD therapy as part of a clinical trial. 83 of these patients received G-CSF to prevent neutropenia. Of the 579 patients who did not receive G-CSF, 453 were given G-CSF at a later stage of treatment.

Overall, rates of side effects due to therapy were 90% with G-CSF and 100% without G-CSF. Rates of severe or life-threatening side effects were 57% with and 87% without G-CSF. 54% of patients without and 46% of patients with G-CSF faced nausea. Severe neutropenia occurred in 29% of cases with G-CSF and 70% cases without G-CSF. 11% of patients with G-CSF faced severe FN, compared to 21% of those without G-CSF.

Patients with G-CSF had 26% lower risks of disease progression compared to those without G-CSF treatment. The proportion of patients surviving for 2 years without a disease progression were 84.6% in the G-CSF group and 81.7% in the no-G-CSF group.

The study concluded that G-CSF treatment reduced the occurrence and severity of treatment-related side effects and improved survival without disease progression in patients with newly diagnosed stage-III/IV HL treated with BV plus AVD.

This study was an additional analysis of an ongoing trial. The dose and duration of G-CSF were different among patients. This might have influenced the results.