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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 5.0 Neutrophil Count Decreased1

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NCI Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 Neutrophil Count Decreased1
Grade ANC
0 Normal
1 ≥1500/mm3 to LLN
2 ≥1000 to <1500/mm3
3 ≥500 to <1000/mm3
4 <500/mm3
ANC, absolute neutrophil count; LLN, lower limit of normal range

WHO Toxicity Criteria2

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WHO Toxicity Criteria2
Grade AGC
0 ≥2000/mm3
1 1500–1900/mm3
2 1000–1400/mm3
3 500–900/mm3
4 <500/mm3
AGC, absolute granulocyte count; WHO, World Health Organization

Examples of Regimens with >20% Risk of Febrile Neutropenia3

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Examples of Regimens with >20% Risk of Febrile Neutropenia3
Cancer Type Regimen
Acute lymphoblastic leukemia Use of growth factor varies according to protocol
Bladder cancer Dose-dense MVAC (methotrexate, vinblastine, doxorubicin, cisplatin)
Bone cancer VAI (vincristine, doxorubicin or dactinomycin, ifosfamide)
VDC-IE (vincristine, doxorubicin or dactinomycin, and cyclophosphamide alternating with ifosfamide and etoposide)
Cisplatin, doxorubicin
VDC (vincristine, doxorubicin or dactinomycin, cyclophosphamide)
VIDE (vincristine, ifosfamide, doxorubicin or dactinomycin, etoposide)
Breast cancer Dose-dense AC→T (doxorubicin, cyclophosphamide, paclitaxel)
Docetaxel, cyclophosphamide ± trastuzumab
TAC (docetaxel, doxorubicin, cyclophosphamide)
TC(H) (docetaxel, carboplatin, ± trastuzumab)
Colorectal cancer FOLFOXIRI (fluorouracil, leucovorin, oxaliplatin, irinotecan)
Head and neck squamous cell carcinoma TPF (docetaxel, cisplatin, fluorouracil)
Hodgkin lymphoma A+AVD (brentuximab vedotin, doxorubicin, vinblastine, dacarbazine)
Escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone)
Kidney cancer Doxorubicin, gemcitabine
Non-Hodgkin lymphoma Dose-adjusted EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin ± rituximab)
ICE (ifosfamide, carboplatin, etoposide ± rituximab)
Dose-dense CHOP-14 (cyclophosphamide, doxorubicin, vincristine, prednisone ± rituximab)
MINE (mesna, ifosfamide, mitoxantrone, etoposide ± rituximab)
ESHAP (etoposide, methylprednisolone, cisplatin, cytarabine ± rituximab)
Hyper-CVAD (cyclophosphamide, vincristine, doxorubicin, dexamethasone, ± rituximab)
DHAP (dexamethasone, cisplatin, cytarabine ± rituximab)
Melanoma Dacarbazine-based combinations (with: cisplatin, vinblastine, aldesleukin [IL-2], interferon alfa)
Multiple myeloma DT-PACE (dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, etoposide ± bortezomib)
Ovarian cancer Topotecan ± bevacizumab
Pancreatic adenocarcinoma FOLFIRINOX (fluorouracil, leucovorin, irinotecan, oxaliplatin)
Soft tissue sarcoma MAID (mesna, doxorubicin, ifosfamide, dacarbazine)
Small cell lung cancer Topotecan
Testicular cancer VeIP (vinblastine, ifosfamide, cisplatin)
VIP (etoposide, ifosfamide, cisplatin)
TIP (paclitaxel, ifosfamide, cisplatin)

Treatment Overview

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Treatment Overview
Indications for CSFs per ASCO 2015 Guidelines4
Prophylaxis in patients undergoing myelosuppressive chemotherapy
  • As primary prophylaxis in patients at high risk (>20%) of developing FN based on patient-, disease-, and treatment-related factors

  • As primary prophylaxis in patients with diffuse aggressive lymphomas aged ≥65 years treated with curative chemotherapy (CHOP or more aggressive regimens), particularly in patients with comorbidities...

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