Optimal Use of Granulocyte-Colony-Stimulating Factor in Patients With Cancer Who Are at Risk for Chemotherapy-Induced Neutropenia

Carrie Cappozzo

ONF 2004, 31(3), 569-576. DOI: 10.1188/04.ONF.569-576

Purpose/Objectives: To provide an overview of the risks for and occurrence of chemotherapy-induced neutropenia in patients with cancer and its optimal prophylactic management with recombinant human granulocyte-colony-stimulating factor (G-CSF).

Data Sources: Original research, review articles, conference presentations, and published guidelines.

Data Synthesis: Chemotherapy-induced neutropenia is a common serious adverse event, and the risks for it can be predicted on the basis of patient characteristics and the chemotherapy regimen.

Conclusions: Optimal, cost-effective prophylactic management of chemotherapy-induced neutropenia with G-CSF requires the assessment of patient factors and the myelotoxicity of the chemotherapy regimen.

Implications for Nursing: Neutropenia and its complications can be serious adverse events in patients who are treated with chemotherapy. Nurses should be familiar with how to identify patients who are at risk for neutropenia and its complications and should be prepared to discuss the need for first-cycle use of G-CSF with the other members of the treatment team as necessary.

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    References

    Balducci, L., & Yates, J. (2000). General guidelines for the management of older patients with cancer. Oncology (Huntington), 14, 221-227.

    Bennett, C.L., Hynes, D., Godwin, J., Stinson, T.J., Golub, R.M., & Appel-baum, F.R. (2001). Economic analysis of granulocyte colony stimulating factor as adjunct therapy for older patients with acute myelogenous leukemia (AML): Estimates from a Southwest Oncology Group clinical trial. Cancer Investigation, 19, 603-610.

    Beveridge, R.A., Miller, J.A., Kales, A.N., Binder, R.A., Robert, N.J., Harvey, J.H., et al. (1998). A comparison of the efficacy of sargramostim (yeast-derived RhuGM-CSF) and filgrastim (bacteria-derived RhuG-CSF) in the therapeutic setting of chemotherapy-induced myelosuppression. Cancer Investigation, 16, 366-373.

    Blay, J.Y., Chauvin, F., Le Cesne, A., Anglaret, B., Bouhour, D., Lasset, C., et al. (1996). Early lymphopenia after cytotoxic chemotherapy as a risk factor for febrile neutropenia. Journal of Clinical Oncology, 14, 636-643.

    Bodey, G.P., Buckley, M., Sathe, Y.S., & Freireich, E.J. (1966). Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Annals of Internal Medicine, 64, 328-340.

    Bonadonna, G., & Valagussa, B.S. (1981). Dose-response effect of adjuvant chemotherapy in breast cancer. New England Journal of Medicine, 304, 10-15.

    Bonadonna, G., Valagussa, P., Moliterni, A., Zambetti, M., & Brambilla, C. (1995). Adjuvant cyclophosphamide, methotrexate, and fluorouracil in node-positive breast cancer: The results of 20 years of follow-up. New England Journal of Medicine, 332, 901-906.

    Bronchud, M.H., Potter, M.R., Morgenstern, G., Blasco, M.J., Scharffe, J.H., Thatcher, N., et al. (1988). In vitro and in vivo analysis of the effects of recombinant human granulocyte colony-stimulating factor in patients. British Journal of Cancer, 58, 64-69.

    Budman, D.R., Berry, D.A., Cirrincione, C.T., Henderson, I.C., Wood, W.C., Weiss, R.B., et al. (1998). Dose and dose intensity as determinants of outcome in the adjuvant treatment of breast cancer. The Cancer and Leukemia Group B. Journal of the National Cancer Institute, 90, 1205-1211.

    Burg, N.D., & Pillinger, M.H. (2001). The neutrophil: Function and regulation in innate and humoral immunity. Clinical Immunology, 99, 7-17.

    Caggiano, V., Stolshek, B., Delgado, D., & Carter, W. (2001). First and all-cycle febrile neutropenia hospitalization (FNH) and costs in intermediate grade non-Hodgkin's lymphoma (IGL) patients on standard-dose CHOP therapy [Abstract]. Blood, 98(Suppl. 1), 431a.

    Cebon, J., Layton, J.E., Maher, D., & Morstyn, G. (1994). Endogenous haemopoietic growth factors in neutropenia and infection. British Journal of Haematology, 86, 265-274.

    Chatta, G.S., Price, T.H., Stratton, J.R., & Dale, D.C. (1994). Aging and marrow neutrophil reserves. Journal of the American Geriatrics Society, 42(1), 77-81.

    Crawford, J., Kreisman, H., Garewal, H., Jones, S.E., Shoemaker, D., Pupa, M.R., et al. (1997). The impact of filgrastim schedule variation on hemato-poietic recovery post-chemotherapy. Annals of Oncology, 8, 1117-1124.

    Crawford, J., Ozer, H., Stoller, R., Johnson, D., Lyman, G., Tabarra, l., et al. (1991). Reduction by granulocyte colony-stimulating factor of fever and neutropenia induced by chemotherapy in patients with small-cell lung cancer. New England Journal of Medicine, 325, 164-170.

    Dexter, T.M., & Testa, N.G. (1993). Haematopoietic growth factors: Review of biology and clinical potential. Cheshire, England: Gardiner-Caldwell.

    Feld, R. (2000). Multinational cooperation in trials and guidelines dealing with febrile neutropenia. International Journal of Antimicrobial Agents, 16, 185-187.

    Frampton, J.E., Lee, C.R., & Faulds, D. (1994). Filgrastim: A review of its pharmacological properties and therapeutic efficacy in neutropenia. Drugs, 48, 731-760.

    Fujisawa, M., Kobayashi, Y., Okabe, T., Takaku, F., Komatsu, Y., & Itoh, S. (1986). Recombinant human granulocyte colony-stimulating factor induces granulocytosis in vivo. Japanese Journal of Cancer Research, 77, 866-869.

    George, S., Yunus, F., Yang, B.B., Hackett, J., Neumann, T., & Liang, B. (2001). Pharmacokinetic profiles of fixed dose single pegfilgrastim administration in patients with non-Hodgkin's lymphoma [Abstract]. Blood, 98(Suppl. 2), 27b.

    Gómez, H., Hidalgo, M., Casanova, L., Colomer, R., Pen, D.L., Otero, J., et al. (1998). Risk factors for treatment-related death in elderly patients with aggressive non-Hodgkin's lymphoma: Results of a multivariate analysis. Journal of Clinical Oncology, 16, 2065-2069.

    Green, M.D., Koelbl, H., Baselga, J., Galid, A., Guillem, V., Gascon, P., et al. (2003). A randomized double-blind multicenter phase III study of fixed-dose single-administration pegfilgrastim versus daily filgrastim in patients receiving myelosuppressive chemotherapy. Annals of Oncology, 14, 29-35.

    Hartmann, L.C., Tschetter, L.K., Habermann, T.M., Ebbert, L.P., Johnson, P.S., Mailliard, J.A., et al. (1997). Granulocyte colony-stimulating factor in severe chemotherapy-induced afebrile neutropenia. New England Journal of Medicine, 336, 1776-1780.

    Holmes, F.A., Jones, S.E., O'Shaughnessy, J., Vukelja, S., George, T., Savin, M., et al. (2002). Comparable efficacy and safety profiles of once-per-cycle pegfilgrastim and daily injection filgrastim in chemotherapy-induced neutropenia: A multicenter dose-finding study in women with breast cancer. Annals of Oncology, 13, 903-909.

    Holmes, F.A., O'Shaughnessy, J.A., Vukelja, S., Jones, S.E., Shogan, J., Savin, M., et al. (2002). Blinded, randomized, multicenter study to evaluate single administration pegfilgrastim once per cycle versus daily filgrastim as an adjunct to chemotherapy in patients with high-risk stage II or stage III/IV breast cancer. Journal of Clinical Oncology, 20, 727-731.

    Intragumtornchai, T., Sutheesophon, J., Sutcharitchan, P., & Swasdikul, D. (2000). A predictive model for life-threatening neutropenia and febrile neutropenia after the first course of CHOP chemotherapy in patients with aggressive non-Hodgkin's lymphoma. Leukemia and Lymphoma, 37, 351-360.

    Johnston, E., Crawford, J., Blackwell, S., Bjurstrom, T., Lockbaum, P., Roskos, L., et al. (2000). Randomized, dose-escalation study of SD/01 compared with daily filgrastim in patients receiving chemotherapy. Journal of Clinical Oncology, 18, 2522-2528.

    Kwak, L.W., Halpern, J., Olshen, R.A., & Horning, S.J. (1990). Prognostic significance of actual dose intensity in diffuse large-cell lymphoma: Results of a tree-structured survival analysis. Journal of Clinical Oncology, 8, 963-977.

    Lieschke, G.J., Grail, D., Hodgson, G., Metcalf, D., Stanley, E., Cheers, C., et al. (1994). Mice lacking granulocyte colony-stimulating factor have chronic neutropenia, granulocyte and macrophage progenitor cell deficiency, and impaired neutrophil mobilization. Blood, 84, 1737-1746.

    Liu, F., Wu, H.Y., Wesselschmidt, R., Kornaga, T., & Link, D.C. (1996). Impaired production and increased apoptosis of neutrophils in granulocyte colony-stimulating factor receptor-deficient mice. Immunity, 5, 491-501.

    Lyman, G.H., Kuderer, N., Greene, J., & Balducci, L. (1998). The economics of febrile neutropenia: Implications for the use of colony-stimulating factors. European Journal of Cancer, 34, 1857-1864.

    Lyman, G.H., Morrison, V.A., Dale, D.C., Crawford, J., Delgado, D.J., & Fridman, M. (2002). Risk of first febrile neutropenia (FN) among patients receiving CHOP chemotherapy [Abstract 1430]. Proceedings of the American Society of Clinical Oncology, 21, 358a.

    Molineux, G., Kinstler, O., Briddell, B., Hartley, C., McElroy, P., Kerzic, P., et al. (1999). A new form of filgrastim with sustained duration in vivo and enhanced ability to mobilize PBPC in both mice and humans. Experimental Hematology, 27, 1724-1734.

    Moore, T., Shiftan, T.A., Knight, C.A., Vongkovit, P., Kalman, L.A., Axelson, J.A., et al. (2001). A prospective trial assessing a risk model for filgrastim use on chemotherapy (CT) dose intensity (DI) in the adjuvant treatment of stage I-III breast cancer patients (BCP) [Abstract 1778]. Proceedings of the American Society of Clinical Oncology, 20, 86.

    Ozer, H., Armitage, J.O., Bennett, C.L., Crawford, J., Demetri, G.D., Pizzo, P.A., et al. (2000). 2000 update of recommendations for the use of hemato-poietic colony-stimulating factors: Evidence-based, clinical practice guidelines. American Society of Clinical Oncology Growth Factors Expert Panel. Journal of Clinical Oncology, 18, 3558-3585.

    Rivera, E., Erder, H.M., Fridman, M., Brannan, C., Frye, D.K., & Hortobagyi, G.N. (2001). Delivering full planned dose on time (PDOT) chemotherapy (CT) while lowering the incidence of febrile neutropenia (FN) hospitalizations: Initial results from a prospective study providing filgrastim support to high risk breast cancer patients (BCP) [Abstract 3]. Breast Cancer Research and Treatment, 69, 209.

    Silber, J.H., Fridman, M., Shpilsky, A., Even-Shoshan, O., Smink, D.S., Jayaraman, J., et al. (1998). Modeling the cost-effectiveness of granulocyte colony-stimulating factor use in early-stage breast cancer. Journal of Clinical Oncology, 16, 2435-2444.

    Tamura, M., Hattori, K., Nomura, H., Oheda, M., Kobuta, N., Imazeki, I., et al. (1987). Induction of neutrophilic granulocytosis in mice by administration of purified human native granulocyte colony-stimulating factor (GCSF). Biochemical and Biophysical Research Communications, 142, 454-460.

    Trillet-Lenoir, V., Green, J., Manegold, C., Von Pawel, J., Gatzemeier, U., Lebeau, B., et al. (1993). Recombinant granulocyte colony stimulating factor reduces the infectious complications of cytotoxic chemotherapy. European Journal of Cancer, 29A, 319-324.

    Welte, K., Gabrilove, J., Bronchud, M.H., Platzer, E., & Morstyn, G. (1996). Filgrastim (r-metHuG-CSF): The first 10 years. Blood, 88, 1907-1929.