myeloid_growth.pdf

Purpose & Patient Population

PURPOSE: To provide guidance in the use of myeloid growth factors in cancer treatment

TYPES OF PATIENTS ADDRESSED: Adult patients

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Consensus-based guideline

PROCESS OF DEVELOPMENT: Process oversight is done by a steering committee. Individual guidelines panels consist of individuals representing member institutions with final selection done by the steering committee. Comments gathered from evidence or institutional reviews are discussed by the panel, and where substantive guideline changes are considered, a panel vote is taken. Recommendations are categorized on the basis of evidence and consensus.

DATABASES USED: PubMed

INCLUSION CRITERIA: Published in English, clinical trials phase II to phase IV, guidelines, meta-analyses, systematic reviews, randomized controlled trials, validation studies

EXCLUSION CRITERIA: Not stated

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results Provided in the Reference

815 references were retrieved. No critical review of evidence was included.

Guidelines & Recommendations

Recommendations are:

Prophylactic use of colony-stimulating factors (CSFs) for individuals at greater than 20% risk for febrile neutropenia (FN) based on chemotherapy regimen, patient risk factors, and treatment intent. For high risk patients (greater than 20%), all treatment intents are considered for CSF recommendation.
Prophylactic use should be considered for all treatment intents in those at 10%–20% risk for FN.
Recommends no CSFs for those with less than a 10% risk for FN
Secondary prophylaxis with CSFs is recommended for consideration among those with FN or a dose-limiting neutropenic event in a prior cycle who had no prior use of CSFs.
Suggests that prophylactic use of biosimilars in the general oncology population at high risk, but inclusion for stem-cell mobilization or use in those with chronic neutropenia has not been fully accepted.

Provides a list of disease and chemotherapy agent types associated with high risk. Studies noted that no current validated algorithm for patient risk factors exists but suggested the following patients: older patients; patients who have undergone chemotherapy or radiation therapy; patients with preexisting neutropenia or bone marrow tumor involvement; patients with preexisting neutropenia, infections, or open wounds; patients who have undergone a recent surgery; patients with poor performance status, poor renal function, liver dysfunction, or HIV infection

Limitations

Limited database to PubMed, no full evidence evaluation provided. Although they suggest prophylaxis based on a percentage risk and suggest chemotherapy dosages accordingly, it does not match current practice in which dosages and regimens may not always be standard, causing a lack of clarity for clinical implementation of these standards.

Nursing Implications

Both chemotherapy regimens as well as patient-specific risk factors need to be considered to determine patients’ level of risk for developing FN. CSFs have been shown to reduce the incidence of FN and some infection events; however, evidence suggests that relevant guidelines and recommendations regarding the use of CSFs are not routinely followed in clinical practice. Nurses can advocate for adherence to CSF prophylaxis in at-risk patients.