Impact of Filgrastim on Mortality During Induction Chemotherapy in Childhood B-Cell Non-Hodgkin Lymphoma.

Background Childhood B-cell non-Hodgkin lymphoma (NHL) is a group of rapidly growing neoplasms that are fatal if left untreated. Induction chemotherapy during the treatment makes these patients vulnerable to several life-threatening infections due to their immunocompromised state. Prophylactic use of filgrastim before initiating the second induction chemotherapy cycle can improve outcomes. Therefore, our study aims to assess various parameters that can lead to acute mortality during induction chemotherapy and how the prophylactic use of filgrastim can prevent it. Methods This retrospective study was performed at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. All patients of B-cell NHL under 10 years of age diagnosed between January 2018 and October 2021 were included. Various parameters including patient age, stage of disease, treatment regimen, day of the start of filgrastim, number of episodes of febrile neutropenia, duration of admission in hospital due to febrile neutropenia, day of count recovery, and outcomes were collected. Results Of the 106 patients, 45 (42.4%) were female and 61 (57.5%) were male; 60 patients (56.7%) were between one and five years of age. All patients were started on granulocyte colony-stimulating factor (G-CSF) on the seventh day of the first induction chemotherapy cycle. A total of 97 patients (91.5%) remained alive until the end of induction, and nine patients (8.5%) succumbed due to febrile neutropenia complications. The median days for filgrastim were eight (0-20) days after completion of the first cycle of COPADM (cyclophosphamide, vincristine, prednisolone, doxorubicin, and methotrexate). On applying the Mann-Whitney U test, there was a significant difference in the day of count recovery among infected and non-infected patients (p = 0.01).  Conclusions Primary prophylactic use of filgrastim can significantly reduce mortality during induction chemotherapy in childhood B-cell NHL. Patients had lower febrile neutropenia episodes, decreased length of hospital stay, and, early count recovery. Therefore, filgrastim before the second cycle of induction chemotherapy, especially in resource-limited settings, can yield better outcomes.