Filgrastim tied to higher ACR burden in lung transplant recipients

Use of filgrastim among lung transplant recipients (LTRs) for the treatment of neutropenia contributes to an increased burden of acute cellular rejection (ACR) and a reduced time to ACR, but not to an increased likelihood of ACR at 6 months, a study has shown.

This matched cohort study of patients transplanted between January 2010 and October 2019 examined the association between filgrastim and ACR incidence 6 months after administration of the study drug. The investigators also assessed other outcomes, including ACR burden, infections, chronic lung allograft dysfunction, and survival.

LTRs treated with filgrastim for neutropenia were compared to those who did not receive such treatment. The investigators matched LTRs based on transplant indication, age, sex, and time post-transplant. They also assessed the likelihood of ACR using multivariable logistic regression models.

A total of 212 patients (106 in each group) were analysed. Of these, 50 patients (47.2 percent) in the filgrastim group and 37 (34.9 percent) in the no filgrastim group had ACR (p=0.070). Multivariable analysis revealed no association between filgrastim use and ACR at 6 months (odds ratio, 1.409, 95 percent confidence interval, 0.772‒2.571).

The filgrastim group also had shorter time to first ACR (p=0.049) and higher 6-month ACR score than the no filgrastim group (0.49 vs 0.33; p=0.047). Furthermore, the filgrastim group showed a higher incidence of bacterial pneumonia and mortality at 1 year.

“This study can help inform clinicians of ACR risk after filgrastim use in LTRs,” the investigators said.