title: First-Cycle CSF use in breast cancer and NHL: guidelines and recommendations.
abstract: Grade 3 and 4 neutropenia as well as febrile neutropenia have been demonstrated to occur in all tumor types and are clearly associated with major morbidity and significant mortality; this is particularly true when myelosuppressive regimens are used with curative intent as is the case in most breast cancer and non-Hodgkin's lymphoma regimens. Myeloid colony-stimulating factors (CSFs) substantially decrease the risk of severe and febrile neutropenia. Although the white cell growth factors might not be cost-effective at lower risks of febrile neutropenia, they clearly benefit other outcomes such as the incidence of severe neutropenia and febrile neutropenia, hospitalization, and mortality. Updated guidelines from the American Society of Clinical Oncology, the National Comprehensive Cancer Network, and the European Organisation for Research and Treatment of Cancer now recommend primary prophylaxis or first-cycle use of white cell growth factors with regimens where the occurrence of febrile neutropenia is approximately 20% (as well as when other risk factors are present). This article briefly describes the rationale for the development of several of the guideline changes as well as highlights some of the ongoing issues related to the use of CSFs.
authors: Hematology and Oncology, Oklahoma University Health Sciences Center, Oklahoma City 73104, USA.
authors: Aref
authors: A
authors: Al-Kali
authors: Howard
authors: H
authors: Ozer
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy*; D003115:Colony-Stimulating Factors / Q000627:therapeutic use*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control*; D011994:Recombinant Proteins
chemical_list: D000970:Antineoplastic Agents; D003115:Colony-Stimulating Factors; D011994:Recombinant Proteins