Supportive Care in Cancer

, Volume 25, Issue 3, pp 817–822 | Cite as

Prevention of granulocyte-colony stimulating factor (G-CSF) induced bone pain using double histamine blockade

Original Article
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Accepted:

Abstract

Purpose

Febrile neutropenia (FN) is an oncological emergency that may reduce patient survival due to chemotherapy dose delays or reductions. It is recommended that patients at risk for FN receive prophylaxis with granulocyte-colony stimulating factor (G-CSF). Bone pain is a common side effect through a mechanism not fully understood. It is thought to be due to histamine release from an inflammatory response.

Methods

This was a retrospective cohort from January to November 2015. Oncology patients receiving an initial dose of G-CSFs rated their bone pain on a 0–10 scale prior to starting each cycle of chemotherapy and at least 1 day after G-CSF had been given. Those who developed bone pain received prophylaxis at their next G-CSF dose with a combination of famotidine and loratadine. The primary endpoint was to determine the analgesic effects of double histamine blockade for G-CSF induced bone pain. The secondary endpoint was to determine potential risk factors for the development of bone pain.

Results

Thirty percent of patients developed bone pain within this cohort, and 17 patients were included in the final analysis. Bone pain scores were lower by a mean of 1.21[(0.20–2.23), p = 0.019] in patients who were prophylaxed with the double histamine blockade. Type of cancer, treatment, age, and BMI were not significant predictors of bone pain.

Conclusion

The use of a double histamine blockade is an inexpensive, safe, and effective way to alleviate bone pain symptoms secondary to G-CSF agents. Further investigation is warranted for prospective larger studies to confirm these results.

Keywords

G-CSF Bone pain Pegfilgrastim Antihistamine Risk factors 
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Notes

Acknowledgements

We thank the Indiana University’s mathematical statistical consult team.

Compliance with ethical standards

Disclosures

None.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of PharmacyIndiana University HealthBloomingtonUSA
  2. 2.Indiana University Health Cancer Care InfusionBloomingtonUSA
  3. 3.Indiana University Health Infusion TherapyBloomingtonUSA

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