title: Granulocyte colony-stimulating factor as secondary prophylaxis of febrile neutropenia in the management of advanced-stage Hodgkin lymphoma treated with adriamycin, bleomycin, vinblastine and dacarbazine chemotherapy: a decision analysis.
abstract: Current practice guidelines are unclear regarding the role of secondary prophylaxis of febrile neutropenia in advanced-stage Hodgkin lymphoma despite several small retrospective studies that demonstrate the omission of growth factors to be a safe and economic practice. We used a decision-analytic model to compare secondary prophylaxis with granulocyte colony-stimulating factor (G-CSF) to no G-CSF with the onset of severe neutropenia for a hypothetical cohort of patients with advanced-stage Hodgkin lymphoma treated with adriamycin, bleomycin, vinblastine and dacarbazine (ABVD). There was a net benefit of 0.017 years and 0.037 quality-adjusted life years for no G-CSF use in severe neutropenia. On microsimulation (10 000 trials), 96% of the simulations showed that the no G-CSF strategy is preferred to the use of G-CSF. This finding was robust across a wide range of sensitivity analyses. Our analysis suggests that G-CSF not be used as secondary prophylaxis of febrile neutropenia in advanced-stage Hodgkin lymphoma.
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Division of Hematology/Oncology , Toronto , Canada.
authors.forename: Joanna
authors.initials: J
authors.lastname: Graczyk
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Cheung
authors.forename: Rena
authors.initials: R
authors.lastname: Buckstein
authors.forename: Kelvin
authors.initials: K
authors.lastname: Chan
mesh_terms: 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; D003661:Decision Support Techniques; D003663:Decision Trees; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D064147:Febrile Neutropenia / Q000139:chemically induced* / Q000188:drug therapy*; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006689:Hodgkin Disease / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D006801:Humans; D008390:Markov Chains; D009367:Neoplasm Staging; D011292:Premedication; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D014747:Vinblastine / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D001761:Bleomycin; D016179:Granulocyte Colony-Stimulating Factor; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin