Efficacy and Safety of Telpegfilgrastim in the Prophylaxis of Chemotherapy-Induced Neutropenia in Patients with Lymphoma: A Retrospective Study

Introduction: Chemotherapy-induced neutropenia (CIN) is a significant complication during cancer chemotherapy, adversely affecting patient outcomes by reducing chemotherapy efficacy and increasing infection risk. Non-Hodgkin lymphoma (NHL) treatment frequently involves chemotherapy regimens with a medium to high risk of febrile neutropenia (FN), with grade 3/4 CIN incidence rates reaching up to 60%. While granulocyte colony-stimulating factor (G-CSF) is effective as a prophylactic measure, it often results in high dosages and adverse effects (AEs). Telpegfilgrastim, a novel pegylated recombinant human G-CSF (PEG-rhG-CSF) with a unique 40KD ‘Y’ PEG structure that differs from others in having a 20KD linear structure, shows promise in reducing CIN with fewer AEs and lower dosages, as demonstrated in non-small cell lung and breast cancer patients. However, its efficacy in lymphoma patients remains underexplored. This study aims to evaluate the efficacy and safety of telpegfilgrastim in preventing CIN in lymphoma patients, providing valuable insights for clinical practice. Methods: We retrospectively analyzed 43 NHL patients undergoing chemotherapy, comprising a total of 95 cycles, treated at Fujian Cancer Hospital from March to July 2024. All patients received telpegfilgrastim 24-48 hours post-chemotherapy to prevent CIN. AEs were categorized according to CTCAE 5.0. The primary outcome was the incidence of grade 3/4 leukopenia and neutropenia per cycle. Secondary outcomes included chemotherapy completion rates and the occurrence of non-hematological AEs. Subgroup analyses focused on patients receiving telpegfilgrastim 24 hours post-chemotherapy and the elderly population, as well as the efficacy of primary prophylaxis. Results: The study cohort had a median age of 66.0 years (range, 10-82), with 28 (65.1%) male patients and 23 (53.5%) aged ≥65 years. Primary prophylaxis was employed in 60% (57/95) of cycles, and telpegfilgrastim was administered 24 hours post-chemotherapy in 72.6% (69/95) of cycles. The incidence rates of grade 3/4 leukopenia and neutropenia per cycle were 12.6% (12/95) and 11.6% (11/95), respectively. Approximately 5.3% (5/95) of cycles required rescue treatment with rhG-CSF, and only 1% (1/95) developed FN infection. In the 24-hour subgroup, the incidences of both grade 3/4 leukopenia and neutropenia were 17.4% (12/69). Additionally, 7.2% (5/69) of cycles required rescue therapy. Primary prophylaxis yielded similar outcomes, with grade 3/4 leukopenia and neutropenia incidences at 11.9% (5/42) in the 24-hour subgroup. Rescue treatment with rhG-CSF was needed in 7.1% (3/42) of cycles. Among elderly patients receiving primary prophylaxis, 29% (6/21) completed three cycles of chemotherapy. AEs were limited to mild bone pain in 3.2% (3/95) of cycles, which was managed symptomatically without affecting subsequent chemotherapy cycles. No instances of nausea or fatigue were recorded. Conclusion: Telpegfilgrastim demonstrated significant advantages in preventing CIN, particularly in patients who received the drug 24 hours post-chemotherapy and in elderly patients in the primary prophylaxis setting. The drug exhibited favorable safety profiles. These findings suggest that telpegfilgrastim is a promising alternative to traditional PEG-rhG-CSF prophylaxis in lymphoma patients.