Clinical Trial: SubCutaneous (SC) Versus Intravenous (IV) Granulocyte Colony Stimulating Factors (G-CSF) for the Treatment of Neutropenia in Hospitalized Haemato-oncological Patients

Study Status: Terminated
Recruit Status: Terminated
Study Type: Interventional

Official Title: Subcutaneous (SC) vs. Intravenous (IV) Granulocyte Colony Stimulating Factors (G-CSF) for the Treatment of Neutropenia in Hospitalized Haemato-oncological Patients: Randomized Controlled Trial

Brief Summary:

Granulocyte colony stimulating factor (G-CSF) is frequently used among patients with cancer including those with haematological malignancies.

Filgrastim is a recombinant human CSF whose biological activity is similar to that of endogenous G-CSF.

In the treatment of chemotherapy-induced neutropenia in patients with various types of cancer CSFs significantly reduced the time to neutrophil recovery and length of hospitalization.


Detailed Summary:

Granulocyte colony stimulating factors (G-CSFs) stimulate the proliferation and differentiation of myeloid progenitor cells, improve cell survival and affect some end-cell functions, through binding to G-CSF receptors present on all cells of the neutrophilic granulocyte lineage. Filgrastim (recombinant G-CSF) is frequently used among patients with cancer including those with haematological malignancies. In-vivo studies and studies in healthy people show that SC administration of CSF results in lower peak but more prolonged and stable levels of G-CSF as compared with Intravenous (IV) administration, with similar or higher neutrophil counts. It is safe to assume that IV administration of G-CSFs would be more comfortable to patients when hospitalized, especially during or after chemotherapy when most patients have a central catheter and are thrombocytopenic. However, it is necessary to ensure that the same effects are obtained with both methods of administration.

Objectives: To compare the time to neutropenia resolution with Intravenous (IV) versus Subcutaneous (SC) filgrastim administration among patients with acute leukemia, lymphoma or multiple myeloma in hospital. Secondarily, the investigators aim to assess comparative rates of infection, adverse effects and patients' satisfaction.

Methods: The investigators plan a randomized controlled trial comparing the effects of IV versus SC filgrastim (Neupogen®) given as per clinical indication on neutrophil counts in hospitalized patients. The investigators will include patients hospitalized in haemato-oncology ward starting filgrastim for the treatment of chemotherapy-induced neutropenia. The investigators will compare SC vs. IV filgrastim, both given as a single daily dose of 5 mcg/kg (rounded to 300 mcg or 480 mcg). No blinding will be used. Patients will be approached to
Sponsor: Rabin Medical Center

Current Primary Outcome:

  • Primary efficacy outcome [ Time Frame: 30 days ]
    Time to stable neutrophil recovery, defined as the number of days from start of filgrastim (day 1) until the neutrophil count has reached >500/mcL for 3 consecutive days
  • Primary safety outcome [ Time Frame: 30 ]
    30-day mortality or documented infection (CDI, MDI, bacteremia or probable/ proven IFI, see definitions below) within the chemotherapy course (before or after neutrophil recovery).


Original Primary Outcome: Time to neutrophil count >500/mcL for 3 consecutive days [ Time Frame: 30 days ]

Time to stable neutrophil recovery, defined as the number of days from start of filgrastim (day 1) until the neutrophil count has reached >500/mcL for 3 consecutive days


Current Secondary Outcome:

  • Will include rates of infection, fever days, hospital stay. [ Time Frame: In-hospital ]
    • Daily neutrophil, monocyte and total white blood cell count during the first 7 days after randomization
    • Number of days with neutrophil count <500/ mcL
    • Number of febrile days
    • Number of days from randomization until discharge
    • Development of clinically documented infections, microbiologically-documented infections and clinically-significant bloodstream infections, not present at the time of randomization
    • Development of possible, probable and proven fungal infections, not present at the time of randomization.
    • Death from any cause at 30 days and before neutropenia resolution
  • Will include patient's satisfaction, other clinical endpoints and adverse events [ Time Frame: 30 days ]
    • Complete remission rate
    • Secondary malignancies, including secondary leukemia and solid tumors
    • Overall survival at 30 days
    • Overall survival at end of study period
    • Patient satisfaction, comparing patients groups and within patient (before and after crossover) differences and patients' selection of administration mode after the trial
    • Adverse events: Phlebitis, local pain at injection site.Bone pain.Allergy


Original Secondary Outcome: Same as current

Information By: Rabin Medical Center

Dates:
Date Received: October 14, 2010
Date Started: January 2011
Date Completion:
Last Updated: April 4, 2016
Last Verified: April 2016