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Cost benefit and clinical efficacy of low‐dose granulocyte colony‐stimulating factor after standard chemotherapy in patients with non‐Hodgkin's lymphoma

High costs of molecule‐targeted drugs, such as rituximab, ibritumomab, and tositumomab have given rise to an economical issue for treating patients with non‐Hodgkin's lymphoma (NHL). Granulocyte colony‐stimulating factors (G‐CSFs), which are also expensive, are widely used for treating neutropenia after chemotherapy. In Japan, lenograstim at 2 μg/kg (about 100 μg/body) or filgrastim at 50 μg/m2 (about 75 μg/body) is commonly administered for patients with NHL after chemotherapy. Therefore, cost‐effectiveness is an important issue in treatment for NHL. Patients with advanced‐stage NHL who needed chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or a CHOP‐like regimen with or without rituximab were enrolled in this randomized cross‐over trial to investigate the efficacy and safety of low‐dose G‐CSF. Half of the patients were administered 75 μg filgrastim in the first course after neutropenia and 50 μg lenograstim in the second course, and the other half were crossed over. Forty‐seven patients were enrolled in this cross‐over trial, and 24 patients completed the trial. Frequencies and durations of grade 4 leukocytopenia and neutropenia were similar in the two groups. Severe infection was rare and was observed at similar frequency. Frequencies of antibiotics use were also similar. The total cost of G‐CSF (cost/drug × duration of administration) was significantly lower in patients who received 50 μg lenograstim. Hence, a low dose of lenograstim might be safe, effective and pharmaco‐economically beneficial in patients with advanced‐stage NHL.