Abstract
Background
The use of granulocyte colony-stimulating factor (G-CSF) as a prophylaxis against febrile neutropenia (FN) is well documented in the literature; however, the therapeutic use of G-CSF in the treatment of FN remains controversial. This study assessed the efficacy of adjunctive G-CSF in the treatment of FN by evaluating clinical outcomes.
Methods
This was a single-center, prospective cohort study conducted at the National Cancer Center in Singapore. Adult patients who had received chemotherapy and developed FN between January 2009 and January 2012 were included in the analysis. The clinical efficacy of adjunctive G-CSF was evaluated by investigating the duration of hospitalization, duration to absolute neutrophil count (ANC) recovery, duration of grade IV neutropenia, duration to fever resolution, duration of antibiotic therapy, and incidence of documented infections. A multivariate analysis was performed to identify patients who could potentially benefit from adjunctive G-CSF.
Results
Four hundred and thirty patients were analyzed. Majority manifested low-risk FN (81.2 %) based on the Multinational Association of Supportive Care in Cancer (MASCC) scoring. Compared to patients who did not receive adjunctive G-CSF, patients receiving adjunctive G-CSF had a nonsignificant reduction in the duration of hospitalization (3.5 vs. 3.7 days, p = 0.41) and in ANC recovery time (3.4 vs. 3.5 days, p = 0.76). Neutropenia-related mortality was lower among those who have received adjunctive G-CSF (2.4 vs. 8.4 %, p = 0.006). Patients of Indian ethnicity and those who underwent gemcitabine-containing chemotherapy were less likely to receive adjunctive G-CSF treatment.
Conclusions
This observational study suggested that adjunctive G-CSF may confer clinical benefits among solid tumor and lymphoma patients with established febrile neutropenia. Further research should be conducted to validate the findings.
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Acknowledgments
We would like to thank Mrs. Ten Eng Lee and Mrs. Betty Yong for their assistance in the data collection. This study was partially funded by a grant received in 2010 from the Healthcare Quality Improvement and Innovation Fund established by the Ministry of Health, Singapore. The sponsor had no role in the design, implementation, analysis, or write-up of this audit.
Conflict of interest
The authors have no conflicts of interest that are directly relevant to the content of this study.
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Chan, A., Wong, Q.X., Ali, M.K. et al. Clinical efficacy of adjunctive G-CSF on solid tumor and lymphoma patients with established febrile neutropenia. Support Care Cancer 22, 1105–1112 (2014). https://doi.org/10.1007/s00520-013-2067-1
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DOI: https://doi.org/10.1007/s00520-013-2067-1