Appropriateness of granulocyte colony-stimulating factor use in patients receiving chemotherapy by febrile neutropenia risk level

ObjectiveInappropriate granulocyte colony-stimulating factor use with myelosuppressive chemotherapy has been reported. Using the Oncology Services Comprehensive Electronic Records electronic medical record database, prophylactic granulocyte colony-stimulating factor (pegfilgrastim/filgrastim) use in cancer patients was assessed by febrile neutropenia risk level.MethodsPatients with nonmetastatic or metastatic breast, head/neck, colorectal, ovarian/gynecologic, lung cancer, or non-Hodgkin’s lymphoma who received myelosuppressive chemotherapy from June 2013 to May 2014 were included. Prophylactic granulocyte colony-stimulating factor use with high-risk, intermediate-risk, and low-risk chemotherapy and distribution of National Comprehensive Cancer Network risk factors with intermediate-risk regimens were assessed.ResultsOverall, 86,189 patients received ∼4.2 million chemotherapy cycles (high risk, 9%; intermediate risk, 48%; low risk, 43%). Prophylactic granulocyte colony-stimulating factor was given in 24% of cycles (high risk, 59%; intermediate risk, 29%; low risk, 11%). For nonmetastatic solid tumors, granulocyte colony-stimulating factor was given in 78% (high risk), 31% (intermediate risk), and 6% (low risk) of cycles. For metastatic solid tumors or non-Hodgkin’s lymphoma, granulocyte colony-stimulating factor was given in 50% (high risk), 27% (intermediate risk), and 11% (low risk) of cycles. Among patients receiving intermediate-risk regimens with granulocyte colony-stimulating factor, febrile neutropenia risk factors were identified in 56% (95% confidence interval, 51.1–60.9%) of patients with nonmetastatic solid tumors (n = 400) and in 70% (64.5–73.5%) of patients with metastatic solid tumors or non-Hodgkin’s lymphoma (n = 400).ConclusionProphylactic granulocyte colony-stimulating factor use was appropriately highest for high-risk regimens and lowest for low-risk regimens yet still potentially underused in high risk regimens, overused in low-risk regimens, and not appropriately targeted in intermediate-risk regimens, indicating a need for further education on febrile neutropenia risk evaluation and appropriate granulocyte colony-stimulating factor use.

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Recombinant Methionyl Human Granulocyte Colony-Stimulating Factor in High-Risk Non-Hodgkin’s Lymphoma Treated with VIM and CHOP: Preliminary Results of a Phase I/II Study

Cytokines in Hemopoiesis, Oncology, and AIDS II ◽

10.1007/978-3-642-48715-6_61 ◽

1992 ◽

pp. 491-495

Author(s):

B. Steinke

Keyword(s):

High Risk ◽

Phase I ◽

Hodgkin’S Lymphoma ◽

Hodgkin's Lymphoma ◽

Granulocyte Colony Stimulating Factor ◽

Colony Stimulating Factor ◽

Preliminary Results ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma ◽

Stimulating Factor

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Prophylactic Use of Filgrastim on Days 7, 11 and 14 in Patients Receiving R-CHOP for Non-Hodgkin's Lymphoma

Blood ◽

10.1182/blood-2019-124329 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 5887-5887

Author(s):

Sherief El- Shakankery ◽

Sumantha Gabriel ◽

Emma Groves

Keyword(s):

Febrile Neutropenia ◽

Elderly Patients ◽

Hodgkin’S Lymphoma ◽

Hospital Admissions ◽

Hodgkin's Lymphoma ◽

Granulocyte Colony Stimulating Factor ◽

Colony Stimulating Factor ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma ◽

Stimulating Factor

Introduction Chemotherapy-induced febrile neutropenia (FN) is a side effect of cytotoxic chemotherapy and a major risk factor for infection as well as a dose-limiting toxicity. One method of reducing the incidence of febrile neutropenia is through the use of granulocyte stimulating factor (G-CSF). Patients with Non-Hodgkin's Lymphoma (NHL) receiving R- CHOP chemotherapy are thought to have a 10-20% risk of FN (Aapro et al 2010). Elderly patients (aged 65 and over) have an elevated risk of FN. The Newcastle upon Tyne Hospitals (NuTH) local guidelines recommend a novel regime prescribing one dose of filgrastim on days 7, 11 and 14 of treatment regime as primary prophylaxis. Several randomised studies and retrospective reviews of practice have examined the question of G-CSF prophylaxis in older patients. There is little doubt that the use of G-CSF as primary prophylaxis in this group reduces the incidence of FN, however the data are conflicting with respect to impact on overall survival (Osby et al 2003. Doorduijn et al 2003) Aims To audit prophylactic G-CSF prescribing against trust guidelines for patients over 65 with NHL receiving R-CHOP chemotherapy. We also assessed the frequency of hospital admissions for FN in patients over 65 receiving curative R-CHOP for NHL. Methods Patients with NHL over 65 who received R-CHOP at NuTH between 01/06/2017 - 31/01/2018 were identified using our electronic chemotherapy prescribing system. Electronic medical records were used to extract patient, chemotherapy, and hospital admission details. A data collection tool was used to record; patient age, cycle number, details about neutropenic sepsis related admissions and neutrophil counts between 1- 4 days prior to a cycle commencing. Results 30 patients with an average age of 73, cumulatively received 138 cycles of R-CHOP during the defined time period. 91.3% (126/138) of G-CSF prescriptions co-prescribed with chemotherapy were in accordance with trust policy. G-CSF on day 7, 11 and 14 corresponded with 8 hospital neutropenic admissions and 0 non-neutropenic. Comparatively 8.7% (12/138) of G-CSF prescriptions were for ≥5 days and corresponded with 5 hospital admissions with FN and 1 non-neutropenic. However, patients who received 5 or more days G-CSF had multiple risk factors for FN or had a previous episode of FN. The average length of admission due to FN was 6 days which has an associated financial implication. 17 chemotherapy prescriptions were dose reduced, of which 82.4% (14/17) were co-prescribed with the day 7, 11 and 14 regime. There were no deaths as a result of neutropenic sepsis in this cohort of 30 patients. Conclusion The NuTH G-CSF regime resulted in FN admission at a rate of 6.35% (8/126). This is lower than the expected rate of 10-20 % in the absence of G-CSF prophylaxis. These data support the use of the modified regimen of filgrastim on days 7, 11 and 14. References Aapro, M.S. et al. 2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours. European Journal of Cancer, Volume 47, Issue 1, 8 - 32 Doorduijn JK, an der Holt B, Imhoff GW, Hem KG, Kramer MHH, Oers MHJ, et al. CHOP compared to CHOP plus granulocyte colony‐stimulating factor in elderly patients with aggressive Non‐Hodgkin's Lymphoma. Journal of Clinical Oncology 2003;21(16):3041‐50. Ösby K, Hagberg H, Kvaloy S, Teerenhovi L, Anderson H, Cavallin‐Stahl E, et al. CHOP is superior to CNOP in elderly patients with aggressive lymphoma while outcome is unaffected by filgrastim treatment: results of a Nordic Lymphoma Group randomized trial. Blood 2003;101(10):3840‐8. Disclosures Gabriel: Abbvie: Consultancy, Speakers Bureau; Jazz: Consultancy, Speakers Bureau; Kite: Honoraria. OffLabel Disclosure: Filgrastim - granulocyte colony stimulating factor

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Granulocyte Colony-Stimulating Factor in Induction Treatment of Children With Non-Hodgkin’s Lymphoma: A Randomized Study of the French Society of Pediatric Oncology

Journal of Clinical Oncology ◽

10.1200/jco.2002.20.2.441 ◽

2002 ◽

Vol 20 (2) ◽

pp. 441-448 ◽

Cited By ~ 2

Author(s):

C. Patte ◽

A. Laplanche ◽

A. I. Bertozzi ◽

A. Baruchel ◽

D. Frappaz ◽

...

Keyword(s):

Febrile Neutropenia ◽

Pediatric Oncology ◽

Hodgkin’S Lymphoma ◽

Hodgkin's Lymphoma ◽

Granulocyte Colony Stimulating Factor ◽

Colony Stimulating Factor ◽

French Society ◽

Median Delay ◽

Non Hodgkin's Lymphoma ◽

Stimulating Factor

PURPOSE: To determine whether granulocyte colony-stimulating factor (G-CSF; lenograstim) decreases the incidence of febrile neutropenia after induction courses in treatment of childhood non-Hodgkin’s lymphoma (NHL). PATIENTS AND METHODS: Patients were randomized to receive (G-CSF+) or not receive (G-CSF−) prophylactic G-CSF, 5 μg/kg/d, from day 7 until an absolute neutrophil count ≥ 500/μL was sustained over 48 hours, after two consecutive induction courses of cyclophosphamide 1.5 or 3 g/m2, vincristine 2 mg/m2, prednisone 60 mg/m2/d × 5, doxorubicin 60 mg/m2, high-dose methotrexate 3 or 8 g/m2, and intrathecal injections (COPAD[M]) on protocols LMB89, LMT89, and HM91 of the French Society of Pediatric Oncology. RESULTS: One hundred forty-eight patients were assessable, 75 G-CSF+ and 73 G-CSF−. Although duration of neutropenia less than 500/μL was 3 days shorter in G-CSF+ patients (P = 10−4), incidence of febrile neutropenia (89% v 93% in the first course, 88% v 88% in the second course), durations of hospitalization and antimicrobial therapy, percentages of infections, mucositis, and transfusions were not significantly different. Although the percentage of G-CSF+ patients commencing the following course on day 21 was significantly higher (84% v 68% after the first and 57% v 38% after the second course; P < .05), the median delay between the two courses was only 1 day less in G-CSF+ patients (median delay after first COPAD(M), 19 v 20 days, P = .01; after second, 21 v 22 days, P = not significant). Remission and survival rates were similar in both arms. CONCLUSION: This study demonstrates that G-CSF did not decrease treatment-related morbidity, nor increase the dose-intensity in children undergoing COPAD(M) induction chemotherapy for NHL.

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