title: Granocyte-colony stimulating factor (G-CSF) has significant efficacy as secondary prophylaxis of chemotherapy-induced neutropenia in patients with solid tumors: results of a prospective study.
abstract: OBJECTIVE
  To carry out a prospective, multicenter and observational study describing prophylactic strategies [cycle delay, dose-reduction, (G-CSF) prescription] to prevent recurrence of neutropenic events (NE) in patients with solid tumors, and identify potential predictive factors of NE recurrence.
  
  
  METHODS
  Patients ≥18 years old with an NE in a previous chemotherapy cycle (cycle A) without G-CSF support, followed for four cycles (B to E) were included in the study. NE was defined as any neutropenia grade 1-4, febrile or not, which impacted on subsequent chemotherapy cycles (cycle delay, or reduction, or prophylactic G-CSF).
  
  
  RESULTS
  Data of 548 patients were analyzed, 378 (69%) were female, with a mean (SD) age of 61.7 (12.3) years. WHO PS: 0-1: 88.3%, incidence of breast cancer: 40%, metastatic disease: 53.3%. Following the first NE episode, 44.5% of patients had cycle delay, 22.3% dose reduction and 466 (85%) received prophylactic G-CSF. NE recurrence rates were: 21.2% at cycle B, 18.6% at cycle C, 11.5% at cycle D and 12.9% at cycle E. G-CSF support (hazard ratio: 0.32, 0.24-0.43, p<0.001) was associated with lower NE recurrence. Pegfilgrastim seemed to offer the highest protection (hazard ratio; HR=0.23, 95% CI: 0.16-0.32; p<0.001).
  
  
  CONCLUSIONS
  Secondary G-CSF prophylaxis has significant efficacy in reducing the incidence of NE and should be considered as a valuable option.
authors.affiliation: Department of Medical Oncology, Lyon-Sud Hospital, 69495 Pierre Bénite Cedex, France. gilles.freyer@chu-lyon.fr
authors.forename: Gilles
authors.initials: G
authors.lastname: Freyer
authors.forename: Nicolas
authors.initials: N
authors.lastname: Jovenin
authors.forename: Gabriel
authors.initials: G
authors.lastname: Yazbek
authors.forename: Christian
authors.initials: C
authors.lastname: Villanueva
authors.forename: Amal
authors.initials: A
authors.lastname: Hussain
authors.forename: Anne
authors.initials: A
authors.lastname: Berthune
authors.forename: Maciej
authors.initials: M
authors.lastname: Rotarski
authors.forename: Hèlène
authors.initials: H
authors.lastname: Simon
authors.forename: Vincent
authors.initials: V
authors.lastname: Boulanger
authors.forename: Michael
authors.initials: M
authors.lastname: Hummelsberger
authors.forename: Claire
authors.initials: C
authors.lastname: Falandry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control*; D011446:Prospective Studies; D055502:Secondary Prevention
chemical_list: D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor