Implications of the European Organisation for Research And Treatment Of Cancer (EORTC) guidelines on the use of granulocyte colony-stimulating factor (G-CSF) for lymphoma care.
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 >or=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.
Pettengell
Ruth
R
Department of Heamatology, St George's University of London, Cranmer Terrace, London, UK. r.pettengell@sgul.ac.uk
Aapro
Matti
M
Brusamolino
Ercole
E
Caballero
Dolores
D
Coiffier
Bertrand
B
Pfreundschuh
Michael
M
Trneny
Marek
M
Walewski
Jan
J
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002626:Chemistry, Pharmaceutical / Q000592:standards; D005060:Europe; D005334:Fever / Q000139:chemically induced / Q000188:drug therapy*; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy* / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D012307:Risk Factors
D016179:Granulocyte Colony-Stimulating Factor