Prophylactic and therapeutic strategies in chemotherapy-induced neutropenia.
BACKGROUND
Neutropenia poses a serious threat to patients on chemotherapy. It exposes them to the risk of infection--including potentially fatal infections--and also leads to delays in treatment and reductions in dose intensity, which can compromise the possibility of a favorable outcome.


METHODS
The use of granulocyte colony-stimulating factors (G-CSF) and antibiotics to prevent febrile neutropenia (FN) and to ameliorate cancer chemotherapy-induced myelosuppression is discussed, based on a systematic search of Pubmed for clinical trials, reviews and meta-analysis published in the last 20 years. We consider that the treatment of FN, with the emphasis on careful attention to the patient, prompts antibiotic therapy and good hospital care.


CONCLUSIONS
We would argue that antibiotic prophylaxis should be offered routinely to patients receiving cytotoxic chemotherapy for acute leukemia and for patients with solid tumors and lymphoma receiving high-dose chemotherapy. In patients undergoing cyclical standard-dose myelosuppressive chemotherapy, we believe that prophylaxis is indicated during the first cycle of chemotherapy in which there is an expectation of grade 4 neutropenia (< 500 neutrophils). However, although the use of antibiotics and haematopoietic growth factors may improve quality of life by reducing the risk and consequences of FN, further study of the magnitude of their effects is needed.
Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece.
Emmanouil
E
Saloustros
Kostas
K
Tryfonidis
Vassilis
V
Georgoulias
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001854:Bone Marrow Cells / Q000187:drug effects*; D003115:Colony-Stimulating Factors / Q000627:therapeutic use*; D032921:Consensus; D004305:Dose-Response Relationship, Drug; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control*; D011788:Quality of Life
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D003115:Colony-Stimulating Factors