Clinical Drug Investigation

, Volume 29, Issue 8, pp 491–513 | Cite as

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

  • Ruth Pettengell
  • Matti Aapro
  • Ercole Brusamolino
  • Dolores Caballero
  • Bertrand Coiffier
  • Michael Pfreundschuh
  • Marek Trneny
  • Jan Walewski
Review Article


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.



Financial support for this review was provided by Amgen Europe GmbH. Gardiner-Caldwell Communications (GCC), Macclesfield, UK assisted in the writing of this review. R. Pettengell has served on advisory boards or received honoraria from Amgen, Bayerhealthcare, Chugai and Roche; M. Aapro has received research grants or honoraria from Roche, Sanofi-Aventis, Sandoz and Chugai; M. Pfreundschuh has served on advisory boards for Roche and Eli Lilly; M. Trneny has received honoraria and research grant support from Amgen; J. Walewski has received honoraria for lectures and consultations from Amgen. The other authors have no conflicts of interest that are directly relevant to the content of this review.


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Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • Ruth Pettengell
    • 1
  • Matti Aapro
    • 2
  • Ercole Brusamolino
    • 3
  • Dolores Caballero
    • 4
  • Bertrand Coiffier
    • 5
  • Michael Pfreundschuh
    • 6
  • Marek Trneny
    • 7
  • Jan Walewski
    • 8
  1. 1.Department of HaematologySt George’s University of LondonLondonUK
  2. 2.Doyen IMO Clinique de GenolierGenolierSwitzerland
  3. 3.Clinica Ematologica, Fondazione Policlinico San Matteo IRCCSUniversità di PaviaPaviaItaly
  4. 4.Haematology DepartmentUniversity HospitalSalamancaSpain
  5. 5.HaematologyCentral Hospital Lyon-SudLyonFrance
  6. 6.Medizinische Klinik IUniversität des SaarlandesHomburgGermany
  7. 7.1st Department of MedicineCharles University in Prague, First Faculty of Medicine and General Teaching HospitalPrahaCzech Republic
  8. 8.The Maria Sklodowska-Curie Memorial Institute and Cancer CentreWarsawPoland

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