Myeloid Growth Factors

Crawford, Jeffrey; Allen, Jeffrey C.; Armitage, Jamés O.; Blayney, Douglas W.; Cataland, Spero R.; Heaney, Mark L.; Htoy, Sally; Hudock, Susan; Kloth, Dwight D.; Kuter, David J.; Lyman, Gary H.; McMahon, Brandon; Steensma, David P.; Vadhan‐Raj, Saroj; Westervelt, Peter; Westmoreland, Michael

doi:10.6004/jnccn.2011.0075

Cited by 29 publications

(36 citation statements)

References 51 publications

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“…These findings suggest physicians placed greater emphasis on individual risk factors when assessing FN risk in patients with lung or ovarian cancer than those with breast cancer, where assessment of high FN risk was more likely to be driven by the choice of chemotherapy. The list of regimens included in guidelines is not exhaustive or conclusive [14–18], and the assignment of FN risk to a chemotherapy regimen was not possible in approximately 40 % of cases (Fig. 2), due to the use of non-standard regimens or variations to standard regimens for which we were unable to find published data regarding the FN risk; this highlights the complexity faced by physicians when evaluating conflicting reports in the guidelines, published literature and expert opinion.…”

Section: Discussionmentioning

confidence: 99%

“…Despite physician assessment of high overall FN risk, a substantial number of patients (45–80 %, Table 3, prespecified analysis) did not receive G-CSF PP as recommended by current guidelines [14–18]. Other studies of clinical practice have also reported poor guideline adherence in high-risk patients with NHL and solid tumours [25–28].…”

Section: Discussionmentioning

confidence: 99%

“…This definition is more closely aligned with the approved product labelling instructions and guidelines [14–18, 20, 21]. Moreover, the on-schedule definition is supported by clinical evidence: The phase 3 registrational studies used the ~24 h after chemotherapy schedule [12, 13] and a comparison of same-day versus next-day pegfilgrastim dosing in breast cancer and NHL patients suggested administration 24 h after chemotherapy provided better efficacy, although differences were not statistically significant [29].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, in breast cancer, pegfilgrastim PP was maintained over a greater number of cycles than filgrastim. Across all tumour types, the number of days of daily G-CSF was lower than recommended, possibly due to the later chemotherapy lines received by patients with lung or ovarian cancer [14–18]. …”

Section: Discussionmentioning

confidence: 99%

“…Clinical guidelines recommend PP with G-CSFs for patients at high (≥20 %) overall FN risk [14–18]. Patients’ overall risk should be assessed at the beginning of each chemotherapy cycle, using the risk associated with their planned regimen and individual risk factors such as older age and advanced disease.…”

Section: Introductionmentioning

confidence: 99%

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Neutropenia management and granulocyte colony-stimulating factor use in patients with solid tumours receiving myelotoxic chemotherapy—findings from clinical practice

Krzemieniecki

Sevelda

Erdkamp

et al. 2013

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PurposeClinical practice adherence to current guidelines that recommend primary prophylaxis (PP) with granulocyte colony-stimulating factors (G-CSFs) for patients at high (≥20 %) overall risk of febrile neutropenia (FN) was evaluated.MethodsAdult patients with breast cancer, non-small cell lung cancer (NSCLC), small-cell lung cancer (SCLC), or ovarian cancer were enrolled if myelotoxic chemotherapy was planned, and they had an investigator-assessed overall FN risk ≥20 %. The primary outcome was FN incidence.ResultsIn total, 1,347 patients were analysed (breast cancer, n = 829; NSCLC, n = 224; SCLC, n = 137; ovarian cancer, n = 157). Patients with breast cancer exhibited fewer individual FN risk factors than patients with other cancers and were far more likely to have received a high-FN-risk chemotherapy regimen. However, a substantial proportion of all patients (45–80 % across tumour types) did not receive G-CSF PP in alignment with investigator risk assessment and guideline recommendations. FN occurred in 127 patients overall (9 %, 95% confidence interval (CI) 8–11 %), and incidence was higher in SCLC (15 %) than other tumour types (8 % in ovarian and NSCLC, 9 % in breast cancer). A post hoc analysis of G-CSF use indicated that G-CSF prophylaxis was not given within the recommended timeframe after chemotherapy (within 1–3 days) or was not continued across all cycles in 39 % of patients.ConclusionsFN risk assessment was predominantly based on clinical judgement and individual risk factors, and guidelines regarding G-CSF PP for patients at high FN risk were not consistently followed. Improved education of physicians may enable more fully informed neutropenia management in patients with solid tumours.Electronic supplementary materialThe online version of this article (doi:10.1007/s00520-013-2021-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Neutropenia management and granulocyte colony-stimulating factor use in patients with solid tumours receiving myelotoxic chemotherapy—findings from clinical practice

Krzemieniecki

Sevelda

Erdkamp

et al. 2013

Support Care Cancer

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Patterns of chemotherapy‐associated toxicity and supportive care in US oncology practice: a nationwide prospective cohort study

et al. 2014

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Neutropenic complications remain an important dose-limiting toxicity of cancer chemotherapy-associated with considerable morbidity, mortality, and cost. Risk of the initial neutropenic event is greatest during the first cycle. The purpose of this study was to better understand timing of neutropenic events in relation to delivered chemotherapy dose intensity and utilization of supportive care during cancer treatment. A prospective cohort study of adult patients with solid tumors or lymphoma initiating chemotherapy was conducted at 115 randomly selected US practice sites between 2002 and 2006. Chemotherapy-associated toxicities were captured in up to four treatment cycles including severe neutropenia, febrile neutropenia, and infection. Documented interventions included colony-stimulating factor (CSF), antibiotics use, and reductions in chemotherapy relative dose intensity (RDI). A total of 3638 patients with breast (39.7%), lung (23.7%), colorectal (13.6%), ovarian (8.3%) cancers, or lymphoma (14.7%) were eligible for this analysis. The majority of neutropenic and infection events occurred in the first cycle. A significant inverse relationship was observed between reductions in neutropenic and infectious events and increased utilization of measures to reduce these complications in subsequent cycles. More than 60% of patients with stage IV solid tumors underwent reductions in RDI. Patients with lymphoma and stage I–III solid tumors had less dose reductions while receiving more prophylactic CSFs. Approximately, 15% of patients received prophylactic antibiotics. While the risk of neutropenic complications remains greatest during the initial cycle of chemotherapy, subsequently instituted clinical measures in efforts to reduce the risk of these events vary with cancer type and stage.

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Primary prophylaxis of bacterial infections and Pneumocystis jirovecii pneumonia in patients with hematological malignancies and solid tumors

et al. 2013

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Bacterial infections are the most common cause for treatment-related mortality in patients with neutropenia after chemotherapy. Here, we discuss the use of antibacterial prophylaxis against bacteria and Pneumocystis pneumonia (PCP) in neutropenic cancer patients and offer guidance towards the choice of drug. A literature search was performed to screen all articles published between September 2000 and January 2012 on antibiotic prophylaxis in neutropenic cancer patients. The authors assembled original reports and meta-analysis from the literature and drew conclusions, which were discussed and approved in a consensus conference of the Infectious Disease Working Party of the German Society of Hematology and Oncology (AGIHO). Antibacterial prophylaxis has led to a reduction of febrile events and infections. A significant reduction of overall mortality could only be shown in a meta-analysis. Fluoroquinolones are preferred for antibacterial and trimethoprim–sulfamethoxazole for PCP prophylaxis. Due to serious concerns about an increase of resistant pathogens, only patients at high risk of severe infections should be considered for antibiotic prophylaxis. Risk factors of individual patients and local resistance patterns must be taken into account. Risk factors, choice of drug for antibacterial and PCP prophylaxis and concerns regarding the use of prophylactic antibiotics are discussed in the review.

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Myeloid Growth Factors

Cited by 29 publications

References 51 publications

Neutropenia management and granulocyte colony-stimulating factor use in patients with solid tumours receiving myelotoxic chemotherapy—findings from clinical practice

Neutropenia management and granulocyte colony-stimulating factor use in patients with solid tumours receiving myelotoxic chemotherapy—findings from clinical practice

Patterns of chemotherapy‐associated toxicity and supportive care in US oncology practice: a nationwide prospective cohort study

Primary prophylaxis of bacterial infections and Pneumocystis jirovecii pneumonia in patients with hematological malignancies and solid tumors

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