Prophylactic Treatment with Stimulating Factors Associated with Neutropenia
According to the results of a study recently published in the Journal of Clinical Oncology, the administration of colony stimulating factors (CSFs) to children before the onset of neutropenia has been shown to decrease febrile (severe) neutropenia, hospitalization, infections, and antibiotic use.
Granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) are substances normally produced by the body that stimulate the growth of blood cells. CSFs have been show to decrease the duration and severity of neutropenia, a dangerous side effect of chemotherapy that involves the presence of a lower than normal number of white blood cells in the body. Neutropenia is a very serious side effect; it can leave the body unable to fight infection. Even slight infections can cause serious illness or death in patients with neutropenia. Also, treatment doses are usually decreased or halted due to neutropenia.
The recent results of CSF use in children were derived from a meta-analysis, which is an evaluation of the results of many trials. Meta-analyses can provide a better understanding of how a treatment works because they take into consideration the results of many trials that were conducted under similar circumstances, rather than just one trial. This meta-analysis included studies that met the following criteria:
- Included children
- Patients were randomly assigned to receive CSFs or placebo/no therapy
- Prophylactic administration of CSF (before neutropenia or febrile neutropenia)
- Chemotherapy treatments before CSFs
Of the 971 studies that were considered for this evaluation, 16 met the criteria and were included.
The Canadian and U.S. researchers that conducted this meta-analysis reported that CSFs were associated with a 20% reduction in febrile (severe) neutropenia and shorter duration of hospitalization. Hospitalizations were decreased by approximately 2 days with CSFs. CSF use was also associated with a 22% reduction in infections and a 50% reduction in antibiotic use. However, there was no difference in infection-related deaths.
The researchers concluded that their findings were consistent with the American Society of Clinical Oncology (ASCO) guidelines, which recommend CSFs for children whose chemotherapy is anticipated to result in febrile neutropenia in 40% or more of cases.
Reference: Sung L, Nathan PC, Lange B, et al. Prophylactic granulocyte-stimulating factor and granulocyte-macrophage colony-stimulating factor decrease febrile neutropenia after chemotherapy in children with cancer: A meta-analysis of randomized controlled trials. Journal of Clinical Oncology. 2004; 22(16):3350-3356.
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