Authors: Pettengell, Ruth¹; Aapro, Matti²; Brusamolino, Ercole³; Caballero, Dolores⁴; Coiffier, Bertrand⁵; Pfreundschuh, Michael⁶; Trneny, Marek⁷; Walewski, Jan⁸

Source: Clinical Drug Investigation, Volume 29, Number 8, 8 August 2009 , pp. 491-513(23)

Publisher: Adis International

Abstract:

Febrile neutropenia (FN) is a potentially life-threatening complication of myelosuppressive chemotherapy. The European Organisation for Research and Treatment of Cancer (EORTC) guidelines recommend use of primary granulocyte colony-stimulating factor (G-CSF) prophylaxis if the overall FN risk to a patient is ≥20%, or if a reduction in chemotherapy dose intensity correlates with a poorer outcome. Many of the regimens used for treatment of lymphoma, including R-CHOP (rituximab combined with cyclophosphamide, doxorubicin, vincristine and prednisolone), are associated with an FN risk of approximately 20% or higher. Individual patient factors that may increase the risk of FN such as advanced age or advanced disease should be taken into account when assessing the need for G-CSF support. Predictive models are being developed to facilitate individual risk assessment. Additional anti-infective prophylaxis may be indicated in some settings. There is now much evidence for the benefits of G-CSF in reducing the incidence of FN and facilitating delivery of chemotherapy, including dose-escalated and dose-dense (interval-reduced) regimens. If given according to guidelines, G-CSF has the potential to reduce FN and related morbidity. Furthermore, by facilitating delivery of planned chemotherapy, use of G-CSF may potentially influence survival in the curative setting. Implementation of the EORTC guidelines will lead to a greater proportion of patients receiving G-CSFs, but the costs involved should be at least partly offset by a reduction in FN and its associated costs, including those of hospitalization.

Document Type: Review article

Affiliations: 1: 1 St George's University of London, London, UK 2: 2 Doyen IMO Clinique de Genolier, Genolier, Switzerland 3: 3 Clinica Ematologica, Fondazione Policlinico San Matteo IRCCS, Università di Pavia, Pavia, Italy 4: 4 Haematology Department, University Hospital, Salamanca, Spain 5: 5 Haematology, Central Hospital Lyon-Sud, Lyon, France 6: 6 Medizinische Klinik I, Universität des Saarlandes, Homburg, Germany 7: 7 1st Department of Medicine, Charles University in Prague, First Faculty of Medicine and General Teaching Hospital, Praha, Czech Republic 8: 8 The Maria Sklodowska-Curie Memorial Institute and Cancer Centre, Warsaw, Poland

Publication date: 2009-08-08

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