Abstract
BackgroundFebrile neutropenia (FN) occurs following myelosuppressive chemotherapy and is associated with morbidity, mortality, costs, and chemotherapy reductions and delays. Granulocyte colony-stimulating factors (G-CSFs) stimulate neutrophil production and may reduce FN incidence when given prophylactically following chemotherapy.MethodsA systematic review and meta-analysis assessed the effectiveness of G-CSFs (pegfilgrastim, filgrastim or lenograstim) in reducing FN incidence in adults undergoing chemotherapy for solid tumours or lymphoma. G-CSFs were compared with no primary G-CSF prophylaxis and with one another. Nine databases were searched in December 2009. Meta-analysis used a random effects model due to heterogeneity.ResultsTwenty studies compared primary G-CSF prophylaxis with no primary G-CSF prophylaxis: five studies of pegfilgrastim; ten of filgrastim; and five of lenograstim. All three G-CSFs significantly reduced FN incidence, with relative risks of 0.30 (95% CI: 0.14 to 0.65) for pegfilgrastim, 0.57 (95% CI: 0.48 to 0.69) for filgrastim, and 0.62 (95% CI: 0.44 to 0.88) for lenograstim. Overall, the relative risk of FN for any primary G-CSF prophylaxis versus no primary G-CSF prophylaxis was 0.51 (95% CI: 0.41 to 0.62). In terms of comparisons between different G-CSFs, five studies compared pegfilgrastim with filgrastim. FN incidence was significantly lower for pegfilgrastim than filgrastim, with a relative risk of 0.66 (95% CI: 0.44 to 0.98).ConclusionsPrimary prophylaxis with G-CSFs significantly reduces FN incidence in adults undergoing chemotherapy for solid tumours or lymphoma. Pegfilgrastim reduces FN incidence to a significantly greater extent than filgrastim.
Highlights
Febrile neutropenia (FN) occurs following myelosuppressive chemotherapy and is associated with morbidity, mortality, costs, and chemotherapy reductions and delays
Guidelines from the European Organisation for Research and Treatment of Cancer (EORTC), [13] the American Society of Clinical Oncology (ASCO) [14] and the National Comprehensive Cancer Network (NCCN) [15] recommend that prophylactic granulocyte colony-stimulating factors (G-CSFs) should be used where the risk of FN associated with the chemotherapy regimen is greater than or equal to 20%, and may be considered where the risk is 1020%, where additional patient risk factors are present
This paper reports a systematic review and meta-analysis of the effect of primary G-CSF prophylaxis on incidence of FN
Summary
Febrile neutropenia (FN) occurs following myelosuppressive chemotherapy and is associated with morbidity, mortality, costs, and chemotherapy reductions and delays. Granulocyte colony-stimulating factors (GCSFs) stimulate neutrophil production and may reduce FN incidence when given prophylactically following chemotherapy. Filgrastim and lenograstim are administered as a series of daily injections; clinical studies suggest an average of 11 injections per chemotherapy cycle are required to achieve recovery of the absolute neutrophil count (ANC) to within the normal range [7,8,9,10]. Guidelines from the European Organisation for Research and Treatment of Cancer (EORTC), [13] the American Society of Clinical Oncology (ASCO) [14] and the National Comprehensive Cancer Network (NCCN) [15] recommend that prophylactic G-CSFs should be used where the risk of FN associated with the chemotherapy regimen is greater than or equal to 20%, and may be considered where the risk is 1020%, where additional patient risk factors are present
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