Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

Incidence of febrile neutropenia and time to count recovery in AML patients receiving pegylated G-CSF following HiDAC consolidation (141733)

Michael Whordley 1 2 , Madeleine Washbourne 1 , Elizabeth Luo 1 , Emily Fitzgerald 1 , Jason Ung 3 , Lynn Peng 3
  1. Princess Alexandra Hospital, Brisbane, Queensland, Australia
  2. School of Pharmacy and Pharmaceutical Sciences, University of Queensland, Herston, Queensland, Australia
  3. Queensland University of Technology, Brisbane, Queensland, Australia

Aim
To review time to count recovery (TTCR) and febrile neutropenia (FN) in differing pegylated granulocyte colony stimulating factors (G-CSF) in Acute Myeloid Leukaemia (AML) patients receiving High-Dose Cytarabine (HiDAC) consolidative chemotherapy. 

Method
A retrospective cohort analysis was conducted between 2018–2025 at a tertiary hospital on AML patients who were administered pegfilgrastim or lipegfilgrastim following HiDAC consolidation. Incidence of FN was defined as absolute neutrophil count (ANC) <0.5x10^9/L with fever and TTCR was defined as ANC reaching >0.5x10^9/L and >1.0x10^9/L after each HiDAC cycle. Subgroup analysis included AML European Leukaemia NET (ELN) risk stratification, HiDAC protocols (1,2,3 vs 1,3,5) and individual cycle comparisons. Data was extracted from electronic medical records. Statistical analyses was performed in R v4.4.1 and using tidyverse and FunnelPlotR packages. 

Results
Eighty-seven patients were identified with 39 patients in the pegfilgrastim cohort and 48 patients in the lipegfilgrastim cohort.  There were 87 cycles of HiDAC from patients who received pegfilgrastim and 127 cycles from lipegfilgrastim. No significant association of FN incidence was found. The average TTCR for ANC >0.5x10^9/L was 15.86 and 19.35 days for pegfilgrastim and lipegfilgrastim respectively (p-value <0.001). TTCR for ANC >1.0x10^9/L was 17.46 and 22.29 days for pegfilgrastim and lipegfilgrastim respectively (p-value <0.001). The use of pegfilgrastim and lipegfilgrastim in HiDAC (1,2,3) demonstrated improved TTCR for ANC >0.5x10^9/L and >1.0x10^9/L compared to HiDAC (1,3,5) by 4.27 days and 5.03 days respectively (p-value <0.001). Risk stratification cohorts of favourable and intermediate had quicker TTCR with pegfilgrastim to ANC >0.5x10^9/L and >1.0x10^9/L compared to lipegfilgrastim (p-value <0.001). Pegfilgrastim showed quicker TTCR for ANC > 0.5x10^9/L and 1.0x10^9/L in individual HiDAC cycles 1, 2 and 3 compared to lipegfilgrastim (p-value < 0.001). 

Conclusion
Lipegfilgrastim was associated with prolonged TTCR compared with pegfilgrastim, without a reduction in the incidence of FN. Larger prospective studies are required to determine clinical relevance.