Clinical Drug Investigation

, Volume 29, Issue 8, pp 491–513

Implications of the European Organisation for Research And Treatment Of Cancer (EORTC) Guidelines on the Use of Granulocyte Colony-Stimulating Factor (G-CSF) for Lymphoma Care


    • Department of HaematologySt George’s University of London
  • Matti Aapro
    • Doyen IMO Clinique de Genolier
  • Ercole Brusamolino
    • Clinica Ematologica, Fondazione Policlinico San Matteo IRCCSUniversità di Pavia
  • Dolores Caballero
    • Haematology DepartmentUniversity Hospital
  • Bertrand Coiffier
    • HaematologyCentral Hospital Lyon-Sud
  • Michael Pfreundschuh
    • Medizinische Klinik IUniversität des Saarlandes
  • Marek Trneny
    • 1st Department of MedicineCharles University in Prague, First Faculty of Medicine and General Teaching Hospital
  • Jan Walewski
    • The Maria Sklodowska-Curie Memorial Institute and Cancer Centre
Review Article

DOI: 10.2165/00044011-200929080-00001

Cite this article as:
Pettengell, R., Aapro, M., Brusamolino, E. et al. Clin. Drug Investig. (2009) 29: 491. doi:10.2165/00044011-200929080-00001


Febrile neutropenia (FN) is a potentially life-threatening complication of myelosuppressive chemotherapy. The European Organisation for Research and Treatment of Cancer (EORTC) guidelines recommend use of primary granulocyte colony-stimulating factor (G-CSF) prophylaxis if the overall FN risk to a patient is ≥20%, or if a reduction in chemotherapy dose intensity correlates with a poorer outcome. Many of the regimens used for treatment of lymphoma, including R-CHOP (rituximab combined with cyclophos-phamide, doxorubicin, vincristine and prednisolone), are associated with an FN risk of approximately 20% or higher. Individual patient factors that may increase the risk of FN such as advanced age or advanced disease should be taken into account when assessing the need for G-CSF support. Predictive models are being developed to facilitate individual risk assessment. Additional anti-infective prophylaxis may be indicated in some settings. There is now much evidence for the benefits of G-CSF in reducing the incidence of FN and facilitating delivery of chemotherapy, including dose-escalated and dose-dense (interval-reduced) regimens. If given according to guidelines, G-CSF has the potential to reduce FN and related morbidity. Furthermore, by facilitating delivery of planned chemotherapy, use of G-CSF may potentially influence survival in the curative setting. Implementation of the EORTC guidelines will lead to a greater proportion of patients receiving G-CSFs, but the costs involved should be at least partly offset by a reduction in FN and its associated costs, including those of hospitalization.

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