Long-term effects of using pegylated recombinant human granulocyte colony-stimulating factor following chemotherapy: A real-world study on patients with ovarian cancer

Pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) is recommended for the prevention of neutropenia during chemotherapy for gynecological tumors. However, its long-term safety is still worth exploring. The present study aimed to explore the long-term effects of the prophylactic use of PEG-rhG-CSF on neutrophils following the completion of first-line chemotherapy during poly(ADP-ribose) polymerase inhibitor (PARPi) maintenance therapy in patients with ovarian cancer. In the present retrospective cohort study, patients were categorized according to whether or not they received prophylactic injections of PEG-rhG-CSF at 24-48 h after the completion of first-line chemotherapy (prophylactic group vs. non-prophylactic group). The primary outcomes were changes in neutrophil and leukocyte levels in both groups. The Mann-Whitney U test with Benjamini-Hochberg correction was used to compare data between the two groups at different time points, and statistical significance for this analysis was defined as a corrected P-value below the adjusted significance threshold (leukocytes, P<0.08; neutrophils, P<0.06; hemoglobin, P<0.04; and platelets, P<0.02). Multivariate linear regression was used to analyze the independent factors influencing the primary outcomes, for which a two-sided P-value of <0.05 was considered statistically significant. The time points observed were at 1, 2, 3 and 6 months, and 1 year following the administration of PARPi. Of the 53 enrolled patients, 20 were in the prophylactic group and 33 were in the non-prophylactic group. Compared with those in the non-prophylactic group, the leukocyte counts in the prophylactic group were significantly lower at 2 months, 6 months and 1 year (P<0.08), the neutrophil counts in the were significantly lower at 3 months and 1 year (P<0.06), and the hemoglobin concentration was significantly lower at 6 months (P<0.04). Multivariate linear regression analysis revealed that parity, pathological type and the prophylactic injection of PEG-rhG-CSF following first-line chemotherapy were independent factors influencing neutrophil and leukocyte counts in the first year following the administration of PARPi (P<0.05). The prophylactic injection of PEG-rhG-CSF reduced neutrophil and leukocyte counts by 2.181x109/l and 2.370x109/l, respectively. On the whole, the present study demonstrates that the prophylactic injection of PEG-rhG-CSF following the completion of first-line chemotherapy may increase the risk of long-term myelosuppression; thus, the prophylactic use of PEG-rhG-CSF should be carefully considered in patients following the completion of first-line chemotherapy.