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FEBRILE NEUTROPENIA

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 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
Docetaxel
Pancreatic adenocarcinoma FOLFIRINOX (fluorouracil, leucovorin, irinotecan, oxaliplatin)
Soft tissue sarcoma MAID (mesna, doxorubicin, ifosfamide, dacarbazine)
Doxorubicin
Doxorubicin/ifosfamide
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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