Updated Guidelines Issued on Reducing Risk of Neutropenia in Patients With Cancer

The American Society of Clinical Oncology (ASCO) has updated its 2006 guidelines on the use of colony-stimulating factors (CSFs) in people with cancer—specifically, adults and children with a solid tumor or lymphoma treated with chemotherapy. The new guidelines are based on a systematic review of randomized clinical trials, meta-analyses, and systematic reviews from October 2005 through September 2014.

CSFs reduce the risk of neutropenia, an abnormally low count of neutrophils (a type of white blood cells) and febrile neutropenia (neutropenia with fever), which are complications of cancer chemotherapy that often require hospitalization. The risk of these complications increases with the severity and length of neutropenia. Using CSFs also allows physicians to use more intensive chemotherapy when it is needed. However, adverse events and costs associated with use of CSFs prompted ASCO to develop and update the latest clinical practice guidelines on their use.

The guidelines address the strengths and limitations of the use of CSFs across a range of settings in clinical oncology, and seek to foster the appropriate use of CSFs based on high-quality evidence from controlled clinical trials and a comprehensive understanding of the specific patient, disease, and treatment factors linked with the risk of neutropenic complications.

The update now includes information on 2 additional FDA-approved CSFs, tbo-filgrastim (Sicor) and filgrastim-sndz (Zarxio); moderation of the recommendation regarding routine use of CSFs in older patients with diffuse aggressive lymphoma; and the addition of recommendations against routine dose-dense chemotherapy in lymphoma and in favor of high-dose intensity chemotherapy in urothelial cancer. The guidelines do not address recommendations about the use of CSFs in acute myeloid leukemia or myelodysplastic syndromes in adults.

The guidelines recommend using CSFs preventively to reduce the risk of febrile neutropenia when the risk is approximately 20% or higher and no other equally effective and safe regimen that does not require CSFs is available. In patients at high risk of febrile neutropenia because of age, medical history, disease characteristics, and myelotoxicity of the chemotherapy regimen, primary prevention is recommended.

The guidelines state that dose-dense regimens of chemotherapy that require CSFs should only be used as part of an appropriately designed clinical trial or if supported by convincing efficacy data.