Crawford, J., Caserta, C., & Roila, F. (2010). Hematopoietic growth factors: ESMO clinical practice guidelines for the applications. Annals of Oncology, 21(Suppl. 5), v248–v251. 

DOI Link

Purpose & Patient Population

PURPOSE: To provide guidelines for the appropriate clinical applications of hematopoietic growth factors
 
TYPES OF PATIENTS ADDRESSED: Adults patients with cancer receiving chemotherapy regimens associated with increased risk for febrile neutropenia (FN)

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Clinical practice guideline
 
PROCESS OF DEVELOPMENT: No process for the development of these guidelines was described
 
SEARCH STRATEGY: None reported

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment 
 
APPLICATIONS: Elder care

Results Provided in the Reference

  • Eighteen citations listed: No evaluative summary of sources or levels of evidence 
  • Note provided by authors on levels of evidence (I-V) and grades of recommendation (A-D) as used by the American Society of Clinical Oncology provided in the tables of recommendations
  • Statements within the guidelines without grading were considered standard clinical practice as recommended by the expert authors and the ESMO faculty

Guidelines & Recommendations

  • Definition: Incidence of FN, complications, and mortality rates
  • Regimens: Risk of FN > 20%
  • Indication: FN primary prophylaxis with ​hematopoietic growth factors (hGFs)
  • Special situations: hGFs and standard therapy
  • Dose schedule: Administration of granulocyte-colony stimulating factor (G-CSF) and pegfilgrastim
  • Indications: Use G-CSF and pegfilgrastim; high-risk situations
  • G-CSF after autologous stem-cell transplant or allogeneic transplant
  • Mobilization of peripheral blood stem cell autologous or allogeneic settings
  • G-CSF treatment for radiation injury
The indications for the use of hGFs as primary prophylaxis include a probability of FN of about 20% based on chemotherapy or special situations and a dose reduction that is deemed detrimental to the patient's outcome. There are special situations for the use of hGFs for standard therapy. hGFs are used as primary prophylaxis if a patient's absolute neutrophil count < 1.5 x 109/l because of the radiotherapy of > 20% marrow, the patient has HIV, the patient is ≥ 65 years and treated with CHOP or more intensive regimens, and for patients with aggressive non-Hodgkin lymphoma. The use of hGFs as secondary prophylaxis if infections in next cycle considered life threatening, dose reduction is below threshold, or lack of protocol adherence that will compromise a survival outcome. Also indicated for therapy with a high-risk for FN. Additionally, hGFs are indicated for high-risk situations including autologous hematopoietic stem cell transplantation (HSCT), allogeneic HSCT, and graft failure. CSFs are indicated for radiation doses of 3–10 Gy with the probability of death from bone marrow failure.

Limitations

  • Data sources before 2010 may be outdated.
  • Not all tumor types and treatments were represented.
  • No process was provided for how these guidelines were developed.
  • The inclusive resources cited were not evaluated separately with a table of evidence.
  • These guidelines were established on expert opinion, consensus of ESMO faculty, and the adoption of ASCO levels of evidence and grades of recommendations.

Nursing Implications

Identifying patients at-risk for FN and the appropriate use of hGFs is critical to improve patient outcomes. Nurses must consider the strength of evidence for and the process of guideline development of treatments before using clinical practice guidelines in patient care.