Advances in the treatment of neutropenia.
OBJECTIVE
The present review updates treatment of neutropenia from articles published from January 2008 through April 2009.


RESULTS
Chemotherapy-induced neutropenia occurs most commonly in the first cycle of treatment. Older patients, patients with multiple comorbidities, and those receiving more myelotoxic drugs are prone to develop neutropenia and its complications. Current guidelines recommend the prophylactic use of the myeloid growth factors for the first cycle of chemotherapy for patients with more than a 20% risk of febrile neutropenia. Meta analysis from randomized trials shows that granulocyte colony-stimulating factor prophylaxis is associated with patients receiving more intensive chemotherapy, having better survival, but also having a higher risk of secondary acute myeloid leukemia. Antibiotics are standard treatment of febrile neutropenia and are increasingly used for prophylaxis in 'low-risk' patients.


CONCLUSIONS
The myeloid growth factor granulocyte colony-stimulating factor has radically changed our approach to the prevention of febrile neutropenia. Antibiotics remain the mainstay of treatment of febrile neutropenia.
Dale
David C
DC
Department of Medicine, University of Washington School of Medicine, Seattle, Washington 98195, USA. dcdale@u.washington.edu
D000367:Age Factors; D019072:Antibiotic Prophylaxis; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015897:Comorbidity; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced* / Q000188:drug therapy / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins; D012307:Risk Factors
D000970:Antineoplastic Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor