Appropriateness of using granulocyte colony-stimulating factor (G-CSF) for primary prophylaxis of febrile neutropenia in solid tumors

Abstract

Introduction Febrile neutropenia (FN) is one of the dose-limiting adverse effects of chemotherapy. Granulocyte-Colony Stimulating Factors (G-CSFs) minimize the incidence of FN and reduce the risk of neutropenia complications. This study was conducted to address the prescription pattern of G-CSF for primary prophylaxis of FN during the first cycle of chemotherapy in solid tumors. Method This prospective observational study was done to investigate the G-CSF prescription pattern in patients receiving the first cycle of chemotherapy for solid tumors and compare it with the NCCN guideline recommendations. Result Based on the guideline, prophylactic G-CSF administration was indicated in 26 of the 96 patients (27.1%) and all of them received G-CSF. On the other hand, 70 patients (72.9%) did not meet the guideline criteria for prophylaxis, but 60 (62.5%) of them received G-CSF. Seven doses of pegfilgrastim and 165 doses of filgrastim were used inappropriately in the study population, which was associated with an economic burden of about 224.7 million IRR (5350 USD). Conclusion Taken together, inconsistencies with the guideline were observed in this prospective evaluation, suggesting that submitting rationalized policies to decrease G-CSF prescription, especially in patients with a lower or intermediate FN risk, yields substantial cost savings.

A Risk-Prediction Nomogram for Neutropenia or Febrile Neutropenia after Etoposide-Based Chemotherapy in Cancer Patients: A Retrospective Cohort Study

“…This visual model is also convenient for helping patients understand and evaluate their own condition. As the risk of neutropenia and its complications varies greatly with different chemotherapy regimens [32], some models have included various chemotherapy regimens and analyzed the effects of each drug on the model. Due to the influence of other conditions of the model [8, 20, 31, 33], some drugs that originally belonged to moderate/high risk may not be found.…”

Immune Dysfunction and Infection – Interaction between CLL and Treatment: A Reflection on Current Treatment Paradigms and Unmet Needs

“…Interactions between specific antimicrobials and specific CLL treatments should be considered when prophylaxis or antimicrobial strategy is chosen [4]. Finally, granulocyte colony stimulating factor (G-CSF) should be implemented for CLL patients affected by neutropenia-associated complications [114]. Despite we currently have minimal information regarding efficacy and survival benefit, it is important to mention that Ig replacement is a viable option for CLL patient affected by recurrent infections and hypogammaglobulinemia [53, 115].…”

Febrile neutropenia prophylaxis, G-CSF physician preferences: discrete-choice experiment

“…An Iranian prospective observational study assessed G-CSF prescription patterns during the first cycle of chemotherapy in patients with solid tumours. 20 Of the 96 patients enrolled, 26 (27%) had primary prophylaxis as recommended (National Comprehensive Cancer Network (NCCN) guidelines). 21 However, in the 70 patients for which G-CSF was not recommended, 60 (79%) patients received G-CSF.…”