title: Predictors of response of patients with solid tumors to granulocyte colony-stimulating factor.
abstract: BACKGROUND
  Granulocyte colony-stimulating factor administration is an important component of supportive therapy in chemotherapy-induced leukopenia. Although patient response to granulocyte colony-stimulating factor administration is known to vary, the factors responsible for poor response have not been identified.
  
  
  OBJECTIVE
  To identify the predictors of the responses of patients with solid tumors to granulocyte colony-stimulating factor.
  
  
  METHODS
  A 600-bed university hospital offering secondary and tertiary care in Japan.
  
  
  METHODS
  This retrospective cohort study examined the response of 181 patients with solid tumors who were administered prophylactic granulocyte colony-stimulating factor for the first time after they developed severe grade 3/4 leukopenia (white blood cell count <2,000 × 10(-9)/L) because of adjuvant or neoadjuvant chemotherapy. The granulocyte colony-stimulating factor response was defined as the length of the leukocyte recovery period, which was assessed as the period within which the normal white blood cell count (white blood cell count >3,000 × 10(-9)/L) is reached after the first dosage of granulocyte colony-stimulating factor. After classification of the patients as either poor or normal granulocyte colony-stimulating factor responders according to the confidence interval of the recovery period, their characteristics were compared.
  
  
  METHODS
  The time for recovery to normal white blood cell count was 2-7 days (90 % confidence interval), and the cutoff value for differentiating poor responders (n = 14) from normal responders (n = 167) was 8 days. Univariate analysis identified previous radiotherapy, number of chemotherapy courses, high granulocyte colony-stimulating factor dosage, and hypoalbuminemia to be significantly associated with granulocyte colony-stimulating factor response. Multivariate analysis identified undergoing four or more chemotherapy courses (odds ratio = 5.09; 95 % confidence interval, 1.14-22.71) and heart failure (odds ratio = 5.96; 95 % confidence interval, 1.09-32.57) to be significantly associated with poor granulocyte colony-stimulating factor response.
  
  
  CONCLUSIONS
  Undergoing four or more chemotherapy courses and heart failure are independent risk factors for poor response to granulocyte colony-stimulating factor. These findings may help prevent the complications of leukopenia during chemotherapy and highlight the need to develop better strategies for preventing and treating infectious disease in patients undergoing granulocyte colony-stimulating factor administration.
authors.affiliation: Department of Pharmacy, University of Fukui Hospital, 23-3, Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan. ohnaka@u-fukui.ac.jp
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ohnaka
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tsukamoto
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Nakamura
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Yano
authors.forename: Kyohei
authors.initials: K
authors.lastname: Watanabe
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Igarashi
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Goto
authors.forename: Mikio
authors.initials: M
authors.lastname: Masada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006333:Heart Failure / Q000150:complications; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D016179:Granulocyte Colony-Stimulating Factor