title: Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update.
abstract: OBJECTIVE
  To update the 2006 American Society of Clinical Oncology guideline on the use of hematopoietic colony-stimulating factors (CSFs).
  
  
  METHODS
  The American Society of Clinical Oncology convened an Update Committee and conducted a systematic review of randomized clinical trials, meta-analyses, and systematic reviews from October 2005 through September 2014. Guideline recommendations were based on the review of the evidence by the Update Committee.
  
  
  RESULTS
  Changes to previous recommendations include the addition of tbo-filgrastim and filgrastim-sndz, moderation of the recommendation regarding routine use of CSFs in older patients with diffuse aggressive lymphoma, and addition of recommendations against routine dose-dense chemotherapy in lymphoma and in favor of high-dose-intensity chemotherapy in urothelial cancer. The Update Committee did not address recommendations regarding use of CSFs in acute myeloid leukemia or myelodysplastic syndromes in adults.
  
  
  CONCLUSIONS
  Prophylactic use of CSFs to reduce the risk of febrile neutropenia is warranted when the risk of febrile neutropenia is approximately 20% or higher and no other equally effective and safe regimen that does not require CSFs is available. Primary prophylaxis is recommended for the prevention of febrile neutropenia in patients who are at high risk on the basis of age, medical history, disease characteristics, and myelotoxicity of the chemotherapy regimen. Dose-dense regimens that require CSFs should only be used within an appropriately designed clinical trial or if supported by convincing efficacy data. Current recommendations for the management of patients exposed to lethal doses of total-body radiotherapy, but not doses high enough to lead to certain death as a result of injury to other organs, include the prompt administration of CSFs.
authors.affiliation: Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Smith
authors.affiliation: Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Kari
authors.initials: K
authors.lastname: Bohlke
authors.affiliation: Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
authors.affiliation: Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Carson
authors.affiliation: Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Crawford
authors.affiliation: Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Cross
authors.affiliation: Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE.
authors.forename: John M
authors.initials: JM
authors.lastname: Goldberg
authors.affiliation: Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE.
authors.forename: James L
authors.initials: JL
authors.lastname: Khatcheressian
authors.affiliation: Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Natasha B
authors.initials: NB
authors.lastname: Leighl
authors.affiliation: Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Perkins
authors.affiliation: Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE.
authors.forename: George
authors.initials: G
authors.lastname: Somlo
authors.affiliation: Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE.
authors.forename: James L
authors.initials: JL
authors.lastname: Wade
authors.affiliation: Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Antoinette J
authors.initials: AJ
authors.lastname: Wozniak
authors.affiliation: Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE.
authors.forename: James O
authors.initials: JO
authors.lastname: Armitage
mesh_terms: D064146:Chemotherapy-Induced Febrile Neutropenia / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control*; D000069585:Filgrastim / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use*; D006401:Hematologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007962:Leukocytes / Q000187:drug effects*; D008495:Medical Oncology / Q000592:standards*; D018579:Patient Selection; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D006401:Hematologic Agents; D000069585:Filgrastim