title: Intermittent granulocyte colony-stimulating factor maintains dose intensity after ABVD therapy complicated by neutropenia.
abstract: BACKGROUND
  Granulocyte Colony-Stimulating Factor (G-CSF) is commonly used to maintain dose intensity in patients receiving ABVD chemotherapy (doxorubicin, bleomycin, vinblastine and dacarbazine) for Hodgkin lymphoma. However, the need for growth factor support is unclear, with studies suggesting that dose intensity can be maintained without G-CSF. Moreover, G-CSF is expensive (pegfilgrastim: EUR 1540/cycle; 300 μg filgrastim for 7 days: EUR 700/cycle) and is associated with side effects including bone pain and increased risk of bleomycin lung toxicity. Intermittent G-CSF may be an effective compromise, given that the effect of G-CSF on granulocyte precursors in vitro persists for 4-5 days after administration. After promising results of a pilot study, this schedule has been used subsequently in the majority of our patients receiving G-CSF as secondary prophylaxis for ABVD complicated by neutropenia.
  
  
  METHODS
  Retrospective analysis of the incidence of febrile neutropenia and treatment delay in a variety of different G-CSF schedules used as secondary prophylaxis in patients receiving ABVD.
  
  
  RESULTS
  848 cycles in 85 consecutive patients were evaluated. Most patients (86%) received G-CSF, generally commenced prophylactically for neutropenia when cycle 1B was due. Intermittent G-CSF (typically given on days 4, 8 and 12) was used in 413 cycles compared with daily or pegylated G-CSF in 99 cycles. In patients receiving intermittent G-CSF, the median neutrophil count, across all cycles, was 7.3 × 10(9) /L (range: 1.4-47.1) when the next scheduled chemotherapy was due. There were two cases of febrile neutropenia (0.45%) and no treatment delays. One patient developed possible bleomycin toxicity.
  
  
  CONCLUSIONS
  Intermittent G-CSF is effective in maintaining dose intensity in patients receiving ABVD.
authors.affiliation: Department of Clinical Haematology, Austin Health, Heidelberg, Victoria, Australia.
authors.forename: Prahlad
authors.initials: P
authors.lastname: Ho
authors.forename: Peter
authors.initials: P
authors.lastname: Sherman
authors.forename: Andrew
authors.initials: A
authors.lastname: Grigg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000009:adverse effects / Q000627:therapeutic use; D003606:Dacarbazine / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced*; D012189:Retrospective Studies; D014747:Vinblastine / Q000009:adverse effects / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D001761:Bleomycin; D016179:Granulocyte Colony-Stimulating Factor; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin