Sari, N., Dalva, K., & Ilhan, I.E. (2013). Comparison of filgrastim and lenograstim in pediatric solid tumors. Pediatric Hematology and Oncology, 30, 655–661.

DOI Link

Study Purpose

To compare the effectiveness, toxicities, and cost of two granulocyte colony-stimulating factor (G-CSF) preparations

Intervention Characteristics/Basic Study Process

Patients were randomized to two group—one receiving filgrastim and one receiving lenograstim  after one chemotherapy treatment cycle. Patients then crossed over to the opposite preparation for the next chemotherapy cycle.

Sample Characteristics

  • N = 29
  • AGE RANGE = 2–16 years
  • MALES: 62%, FEMALES: 38%
  • KEY DISEASE CHARACTERISTICS: Multiple tumor types; most frequent were Ewing sarcoma, osteosarcoma, and neuroblastoma

Setting

  • SITE: Single site 
  • SETTING TYPE: Multiple settings 
  • LOCATION: Turkey

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment
  • APPLICATIONS: Palliative care

Study Design

  • Crossover, randomized, two-group trial

Measurement Instruments/Methods

Febrile neutropenia was defined as absolute neutrophil count less than .05x103 cells per µL and oral or axillary temperature above 38.3 degrees centigrade or 38.0 for more than one hour.

Results

No differences were seen in treatments in febrile neutropenia, antibiotic use, rate of infection, use of platelet transfusions, or hospitalization. Cost was significantly lower with filgrastim (p = .002). No differences were seen between treatments in adverse effects. Bone pain was the most frequent side effect, with no significant differences between treatments

Conclusions

Findings suggest that efficacy and side effects of filgrastim and lenograstim are equivalent. Filgrastim use was less costly.

Limitations

  • Small sample (less than 100)
  • Risk of bias (no blinding)
  • Other limitations/explanation: Patients had a variety of diseases and were getting a wide variety of chemotherapy treatments given the small sample size, which potentially would impact the risk of febrile neutropenia.

Nursing Implications

Findings show that both of these G-CSF formulations provide similar results but differ substantially in cost. Nurses can advocate for less costly alternatives for care according to patients’ financial situations. The main side effect for patients is bone pain, which needs to be addressed effectively.