Lenograstim is a recombinant glycosylated human
granulocyte colony-stimulating factor (rHuG-CSF) which principally regulates the formation and function of neutrophils. Like other
colony-stimulating factors (CSFs),
lenograstim has been developed for the prevention and treatment of iatrogenic and disease-related neutropenic conditions. In phase III clinical studies, prophylactic administration of
lenograstim shortened the duration of
chemotherapy-induced
neutropenia in patients with nonmyelogenous
cancers who received standard-dose
chemotherapy or myeloablative regimens followed by
bone marrow transplantation (BMT). A decrease in the incidence of
infection after standard regimens and fewer days with infectious and febrile neutropenic episodes during recovery from BMT occurred concomitantly with the amelioration of
neutropenia. In each setting, the decrease in morbidity was associated with shorter hospitalisation times and reduced administration of parenteral
antibacterial agents. As with another rHuG-CSF,
filgrastim, bone
pain (non-serious) was the most common adverse reaction to
lenograstim therapy. This occurred in 13% of
lenograstim recipients and 5% of placebo recipients treated for
chemotherapy-induced
neutropenia with standard regimens.
Lenograstim may facilitate dose optimisation and permit limited dose intensification of standard
chemotherapy. Furthermore, the
drug, used alone or in combination with
chemotherapy, is effective in mobilising peripheral blood progenitor cells (PBPCs) for subsequent reinfusion. The latter is a promising technique which may supplement or ultimately replace BMT for stem cell rescue after myeloablative
chemotherapy. However, it has yet to be established whether the dose intensification achievable with
lenograstim and/or stem cell rescue has a material effect on relapse-free and survival times. Preliminary data suggest that
lenograstim is effective in increasing the neutrophil count in patients with
severe chronic neutropenia (
Kostmann's syndrome), as well as patients with
AIDS or
AIDS-related complex with
zidovudine-induced
neutropenia. Thus,
lenograstim, like other CSFs, is a valuable adjunct to cytotoxic
chemotherapy for the treatment of nonmyelogenous
cancers, including myeloablative regimens followed by stem cell rescue with BMT and/or PBPC infusion. Future clinical experience is likely to confirm the usefulness of the
drug in the management of disease-related
neutropenia, myeloid disorders and
neutropenia in patients with
AIDS.