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Therapeutic use of granulocyte colony-stimulating factor (G-CSF) in patients with febrile neutropenia: a comprehensive systematic review for clinical practice guidelines for the use of G-CSF 2022 from the Japan Society of Clinical Oncology

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Abstract

Background

Febrile neutropenia represents a critical oncologic emergency, and its management is pivotal in cancer therapy. In several guidelines, the use of granulocyte colony-stimulating factor (G-CSF) in patients with chemotherapy-induced febrile neutropenia is not routinely recommended except in high-risk cases. The Japan Society of Clinical Oncology has updated its clinical practice guidelines for the use of G-CSF, incorporating a systematic review to address this clinical question.

Methods

The systematic review was conducted by performing a comprehensive literature search across PubMed, the Cochrane Library, and Ichushi-Web, focusing on publications from January 1990 to December 2019. Selected studies included randomized controlled trials (RCTs), non-RCTs, and cohort and case–control studies. Evaluated outcomes included overall survival, infection-related mortality, hospitalization duration, quality of life, and pain.

Results

The initial search yielded 332 records. Following two rounds of screening, two records were selected for both qualitative and quantitative synthesis including meta-analysis. Regarding infection-related mortality, the event to case ratio was 5:134 (3.73%) in the G-CSF group versus 6:129 (4.65%) in the non-G-CSF group, resulting in a relative risk of 0.83 (95% confidence interval, 0.27–2.58; p = 0.54), which was not statistically significant. Only median values for hospitalization duration were available from the two RCTs, precluding a meta-analysis. For overall survival, quality of life, and pain, no suitable studies were found for analysis, rendering their assessment unfeasible.

Conclusion

A weak recommendation is made that G-CSF treatment not be administered to patients with febrile neutropenia during cancer chemotherapy. G-CSF treatment can be considered for patients at high risk.

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Acknowledgements

The authors would like to thank Ms. Keiko Kato for conducting the initial literature search and Professor Masahiro Yoshida of Minds Tokyo Grading of Recommendations, Assessment, Development, and Evaluation Center for his advice regarding methodology. We would also like to thank Ms. Natsuki Fukuda for providing assistance to the study to formulate these guidelines.

Author information

Authors and Affiliations

  1. Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan

    Kenji Tsuchihashi & Mamoru Ito

  2. Department of Gastrointestinal and Medical Oncology, NHO Kyushu Cancer Center, Fukuoka, Japan

    Yuta Okumura

  3. Department of Medical Oncology, Hamanomachi Hospital, Fukuoka, Japan

    Kenta Nio

  4. Department of Breast Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Yukinori Ozaki & Toshimi Takano

  5. Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan

    Hiroshi Nishio

  6. Center for Clinical Oncology, Okayama University Hospital, Okayama, Japan

    Eiki Ichihara

  7. Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan

    Yuji Miura

  8. Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan

    Makoto Endo

  9. Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan

    Shingo Yano

  10. Department of Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Dai Maruyama

  11. Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan

    Tetsuhiro Yoshinami

  12. Department of Obstetrics and Gynecology, International University of Health and Welfare Narita Hospital, Chiba, Japan

    Nobuyuki Susumu

  13. Department of Gynecology, Shizuoka Cancer Center, Shizuoka, Japan

    Munetaka Takekuma

  14. Department of Obstetrics and Gynecology, Tokyo Women’s Medical University Hospital, Tokyo, Japan

    Takashi Motohashi

  15. Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan

    Nobuaki Ochi

  16. Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan

    Toshio Kubo

  17. Department of Medical Oncology, NTT Medical Center Tokyo, Tokyo, Japan

    Keita Uchino

  18. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan

    Takahiro Kimura

  19. Department of Clinical Oncology/Hematology, The Jikei University School of Medicine, Tokyo, Japan

    Yutaro Kamiyama

  20. Department of Hematology, Faculty of Medicine, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan

    Shinji Nakao

  21. Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan

    Shinobu Tamura

  22. Department of Nursing, Okayama University Hospital, Okayama, Japan

    Hitomi Nishimoto

  23. Department of Drug Information, Faculty of Pharmaceutical Sciences, Shonan University of Medical Sciences, Kanagawa, Japan

    Yasuhisa Kato

  24. Department of Medical Oncology, Hirosaki University Graduate School of Medicine, Aomori, Japan

    Atsushi Sato

  25. Department of Oncology and Social Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Eishi Baba

Authors
  1. Kenji Tsuchihashi
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  2. Mamoru Ito
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  3. Yuta Okumura
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  4. Kenta Nio
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  5. Yukinori Ozaki
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  6. Hiroshi Nishio
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  7. Eiki Ichihara
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  8. Yuji Miura
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  9. Makoto Endo
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  10. Shingo Yano
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  11. Dai Maruyama
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  12. Tetsuhiro Yoshinami
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  13. Nobuyuki Susumu
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  14. Munetaka Takekuma
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  15. Takashi Motohashi
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  16. Nobuaki Ochi
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  17. Toshio Kubo
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  18. Keita Uchino
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  19. Takahiro Kimura
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  20. Yutaro Kamiyama
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  21. Shinji Nakao
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  22. Shinobu Tamura
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  23. Hitomi Nishimoto
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  24. Yasuhisa Kato
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  25. Atsushi Sato
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  26. Toshimi Takano
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  27. Eishi Baba
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Contributions

This study forms part of the updating of the Clinical Practice Guidelines for the Use of G-CSF, under the chairmanship of T.T. All authors contributed to the conceptualization and design of this study. The formal analysis was conducted by Y.O., K.N., and E.B.; K.T. and M.I. undertook the review of the analyzed data. The initial draft of the manuscript was composed by K.T., with E.B. providing supervision. M.I., Y.O., and K.N. reviewed and edited the draft. All authors read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Eishi Baba.

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Conflict of interest

Kenji Tsuchihashi has received honoraria from Ono Pharmaceutical Co. Ltd., Chugai Pharmaceutical Co., Taiho Pharmaceutical Co. Ltd., and Novartis Pharmaceutical. K.K. Yukinori Ozaki has received honoraria from Daiichi Sankyo Co. Ltd., Pfizer Japan Inc., Chugai Pharmaceutical Co. Ltd., Eli Lilly Japan K.K., and Kyowa Kirin Co. Ltd. Eiki Ichihara has received honoraria from Eli Lilly Japan K.K. and research funding from MSD K.K., Ono Pharmaceutical Co. Ltd., Janssen Pharmaceutical K.K., and Takeda Pharmaceutical Co. Ltd. Yuji Miura has received honoraria from Ono Pharmaceutical Co. Ltd., MSD K.K., Takeda Pharmaceutical Co. Ltd., Eisai Co. Ltd., and Bristol Myers Squibb Co. Ltd., and research funding from MSD K.K. and Ono Pharmaceutical Co. Ltd. Shingo Yano has received research funding from Otsuka Pharmaceutical Co. Ltd. Dai Maruyama has received honoraria from Ono Pharmaceutical Co. Ltd., Janssen Pharmaceutical K.K., Nippon Shinyaku Co. Ltd., Eisai Co. Ltd., Mundipharma, Kyowa Kirin Co. Ltd., Chugai Pharmaceutical Co. Ltd., Zenyaku Holdings Co. Ltd., MSD K.K., SymBio Pharmaceutical Ltd., Sanofi K.K., AbbVie Inc., Takeda Pharmaceutical Co. Ltd., AstraZeneca K.K., Bristol Myers Squibb Co. Ltd., and Genmab K.K., and research funding from Amgen K.K., Astellas Pharma Inc., Biopharma Co. Ltd., Novartis Pharmaceutical K.K., Kyowa Kirin Co. Ltd., Ono Pharmaceutical Co. Ltd., Chugai Pharmaceutical Co., Janssen Pharmaceutical K.K., Takeda Pharmaceutical Co. Ltd., Otsuka Pharmaceutical Co. Ltd., Sanofi K.K., Bristol Myers Squibb Co. Ltd., AbbVie Inc., Eisai Co. Ltd., MSD K.K., Taiho Pharmaceutical Co. Ltd., AstraZeneca K.K., Eli Lilly Japan K.K., and Genmab K.K. Tetsuhiro Yoshinami has received honoraria from Kyowa Kirin Co. Ltd., Pfizer Japan Inc., Chugai Pharmaceutical Co., Eli Lilly Japan K.K., MSD K.K., AstraZeneca K.K., and Eisai Co. Ltd. Takashi Motohashi has received honoraria from AstraZeneca K.K., Chugai Pharmaceutical Co., and Myriad Genetics G.K. Toshio Kubo has received honoraria from Chugai Pharmaceutical Co. Takahiro Kimura has received honoraria from Sanofi K.K. Shinji Nakao has received honoraria from Kyowa Kirin Co., Ltd. Atsushi Sato has received honoraria from Chugai Pharmaceutical Co. and Taiho Pharmaceutical Co. Ltd., and a scholarship donation from Chugai Pharmaceutical Co. and Taiho Pharmaceutical Co. Ltd. Toshimi Takano has received honoraria from Daiichi Sankyo Co. Ltd., Chugai Pharmaceutical Co., and Eli Lilly Japan K.K. Eishi Baba has received honoraria from Chugai Pharmaceutical Co. Ltd. and Daiichi Sankyo Co.Ltd., and research funding from Taiho Pharmaceutical Co. Ltd. and Chugai Pharmaceutical Co. Ltd.

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Tsuchihashi, K., Ito, M., Okumura, Y. et al. Therapeutic use of granulocyte colony-stimulating factor (G-CSF) in patients with febrile neutropenia: a comprehensive systematic review for clinical practice guidelines for the use of G-CSF 2022 from the Japan Society of Clinical Oncology. Int J Clin Oncol 29, 700–705 (2024). https://doi.org/10.1007/s10147-024-02541-z

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  • DOI: https://doi.org/10.1007/s10147-024-02541-z

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