You Make the Call
Each month in “You Make the Call,” we’ll pick a challenging clinical question
submitted through the Consult-a-Colleague program and post the expert’s
response. But, what would YOU do? We’ll also pose a submitted question
and ask you to send your responses. See how your answer matches up to the
experts’ in the next print issue.
This month, Linda J. Burns, MD, answers a question about the similarities
between TBO-filgrastim and filgrastim.
Clinical Dilemma:
Do you consider TBO-filgrastim identical, in terms of response and tolerance, to filgrastim?
Is it correct to switch 300 µg filgrastim to 300 µg TBO-filgrastim?
• Hematopoietic cell
transplantation
Linda J. Burns, MD
National Marrow Donor Program/Be The Match
Donor Medical Services
Medical Director, Health Services Research
Senior Scientific Director, Center for International
Blood and Marrow Transplant Research
Milwaukee, Wisconsin
• Hemoglobinopathies
• Hemostasis/thrombosis
• Lymphomas
• Lymphoproliferative disorders
• Leukemias
• Multiple myeloma & Waldenström
macroglobulinemia
Recent reviews have shown that filgrastim and TBO-filgrastim (a nonglycosylated recombinant methionyl human
granulocyte colony-stimulating growth factor) are similarly
effective in treating treatment-related febrile neutropenia,
suggesting that it would be correct to switch from 300 µg
filgrastim to 300 µg TBO-filgrastim.
Dosing of filgrastim and TBO-filgrastim are the same,
with similar responses and tolerance, as reported in a literature review of randomized clinical trials, meta-analyses, and
systematic reviews for the use of hematopoietic colony-stimulating factors.1 In the review, filgrastim and TBO-filgrastim
have demonstrated similar safety and efficacy in reducing
the rate of first-cycle treatment-related neutropenia, with an
adjusted difference of 1.7 percent (95% CI 3.8-7.1%) with no
statistically significant difference between the two drugs.
In the setting of autologous hematopoietic cell transplantation, filgrastim and TBO-filgrastim have also demonstrated
comparable safety and efficacy, with no statistically significant differences in mobilization and neutrophil engraftment.2
1. Smith TJ, Bohlke K, Lyman GH, et al. Recommendations for the use of WBC growth factors: American
Society of Clinical Oncology Clinical Practice Guideline update. J Clin Oncol. 2015;33:3199-212.
2. Elayan MM, Horowitz JG, Magraner JM, et al. Tbo-filgrastim versus filgrastim during mobilization and
neutrophil engraftment for autologous stem cell transplantation. Biol Blood Marrow Transplant.
2015;21:1921-5.
Next Month’s Clinical Dilemma:
A 57-year-old woman with a WBC of 6.6
with 67% lymphs and 27.2% grans, HGB
14, MCV 91.2, PLT 23. Flow cytometry on
the peripheral blood: A monoclonal kappa
B-cell pop co-expressing CD5 and CD23
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ASH Clinical News
Consult a Colleague is a service for ASH
members that helps facilitate the exchange of information between hematologists and their peers. ASH members
can seek consultation on clinical cases
from qualified experts in 11 categories:
• Anemias
Experts Make the Call
REFERENCES
Consult a Colleague
Through ASH
• Myeloproliferative Disorders
• Myelodysplastic Syndromes
• Thrombocytopenias
Assigned volunteers (“colleagues”) will
respond to inquiries within two business
days (either by email or phone).
Have a puzzling