Smith, T.J., Bohlke, K., Lyman, G.H., Carson, K.R., Crawford, J., Cross, S.J., . . . American Society of Clinical Oncology. (2015). Recommendations for the use of WBC growth factors: American Society of Clinical Oncology clinical practice guideline update. Journal of Clinical Oncology, 33, 3199–3212. 

DOI Link

Purpose & Patient Population

PURPOSE: To update prior 2006 guidelines for the use of white blood cell (WBC) growth factors
 
TYPES OF PATIENTS ADDRESSED: Adults or children with solid tumor or lymphoma treatment with chemotherapy

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Evidence-based guideline

PROCESS OF DEVELOPMENT: American Society of Clinical Oncology (ASCO) committee members and guidelines staff monitor medical literature to determine update needs, and update committee-drafted guidelines based on results from selected trials and clinical experience.  
 
INCLUSION CRITERIA: Phase-II, randomized controlled trials; systematic reviews; meta-analyses

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results Provided in the Reference

Sixty-six publications formed the evidence base for the recommendations. Forty-one were randomized, controlled trials.

Guidelines & Recommendations

Primary colony-stimulating factor (CSF) prophylaxis starting with the first cycle and continuing in subsequent cycles is recommended for those who have about a 20% or higher risk for febrile neutropenia.
  • Secondary CSF prophylaxis is recommended for patients who have a neutropenic complication from a prior cycle of chemotherapy.
  • CSFs should be administered after an autologous HCT (strong recommendation) and may be administered after allogeneic hematopoietic cell transplantation (HCT) (weak recommendation).
  • The use of CSFs as primary prophylaxis in children is reasonable.
  • Prophylactic CSF for patients with aggressive lymphoma aged 65 and older undergoing curative treatment should be provided (moderate strength recommendation).
The guidelines also suggest that various CSFs and biosimilars are clinically equivalent.

Nursing Implications

The guidelines provide general recommendations for the primary and secondary prophylactic use of CSFs in patients being treated for cancer, and also outlines concerns regarding cost and the potential overuse of CSFs. The determination of a 20% risk for febrile neutropenia was not straightforward given patient variation and regimen alterations according to individual patient responses. Further work is needed to develop and evaluate clear individualized risk-based models for CSF use in a variety of patients with cancer.