Chapter 43: Indications for Growth Factors in Hematology-Oncology

Epidemiology

Febrile neutropenia is a major dose-limiting toxicity of chemotherapy. Studies have demonstrated that selective use of colony-stimulating factors (CSFs) in patients at high-risk for complications of neutropenia can enhance cost-effectiveness by reducing the risk, severity and duration of febrile neutropenia

NCI Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0 Neutrophil Count Decreased³

WHO Toxicity Criteria

Examples of Regimens with >20% Risk of Febrile Neutropenia²

Treatment Overview

NCCN Guidelines^® (V.1.2013)² and ASCO Guidelines (2006 Update)⁵ recommend routine use of CSFs support for patients at high risk (defined >20%) of developing febrile neutropenia who are receiving treatment with curative intent, adjuvant therapy, or treatment expected to prolong survival or to improve quality of life (QOL)^2,5

ASCO Guidelines also recommends CSFs for:

• Patients with diffuse aggressive lymphomas aged ≥65 years treated with curative chemotherapy (CHOP or more aggressive regimens)

• Patients exposed to lethal doses of total-body irradiation (TBI) (CSFs or pegylated G-CSF)⁵

NCCN Guidelines (V.1.2013) also recommend evaluation of patients for the use of myeloid growth factors before every cycle of cytotoxic chemotherapy

• If febrile neutropenia or a dose-limiting neutropenic event previously occurred during chemotherapy without CSFs use, the guidelines recommend considering CSFs use during repeated treatment cycles

• If fever with neutropenia or a dose-limiting ...