Neutropenia

Chapter
First Online:
Part of the Cancer Drug Discovery and Development book series (CDD&D)

Abstract

The development and use of myeloid growth factors in support of cancer patients receiving chemotherapy has had a huge impact on the practice of oncology. While there are several areas of importance, this chapter will focus on the problem of chemotherapy-induced neutropenia and its impact on patient outcomes and potential strategies for management, including dose reduction, prophylactic antibiotics, and myeloid growth factors. In this context, the biology, pharmacology, and pharmacodynamics of myeloid growth factors will be reviewed, as well as the clinical evidence of benefit that have led to the current guidelines for use. Lastly, while the focus will be predominantly around support for chemotherapy-induced neutropenia, the impact of myeloid growth factors in other settings, including high-dose chemotherapy and the management of chronic neutropenia will also be briefly addressed.

Keywords:

Neutropenia Myeloid growth factors Prophylactic antibiotics 
This is a preview of subscription content, log in to check access.

References

  1. 1.
    Bodey G, Buckley M, Sathe Y, Freireich E. 1966; Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med 64:328–340.PubMedGoogle Scholar
  2. 2.
    Crawford J, Blackwell S. 2001. Hematopoietic growth factors. In:Perry MC The Chemotherapy Source Book,3rd.Lippincott Williams & Wilkins,Philadelphia:94–103.Google Scholar
  3. 3.
    Anderson N, Cella D, Calhoun E, et al. Rationale for the development of the FACT-N: a neutropenia-specific quality-of-life tool. Proceedings from the 2003 annual congress of the Oncology Nursing Society. Abstract 117.Google Scholar
  4. 4.
    Lyman G, Kuderer N, Green J, Balducci. 1998; The economics of febrile neutropenia: implications for the use of colony-stimulating factors. Eur J Cancer 34:1857–1864.Google Scholar
  5. 5.
    Bonadonna G, Valagussa B, Moliterni A, Zambetti M, Brambilla C. 1995; Adjuvant Cyclophosphamide, methotrexate, and fluorouracil in node-positive breast cancer — The results of 20 years of follow-up. N Engl J Med 332:901–906.PubMedCrossRefGoogle Scholar
  6. 6.
    Budman D, Berry D, Cirrincione C, Henderson IC, Wood W, Weiss R, Rerree C, Muss H, Green M, Norton L, Frei E. 1998; Dose and dose intensity as determinants of outcome in the adjuvant treatment of breast cancer. J Natl Cancer Inst 90:1205–1211.PubMedCrossRefGoogle Scholar
  7. 7.
    Kwak L, Halpern J, Olshen, RHorning S. 1990; Prognostic significance of actual dose intensity in diffuse large-cell lymphoma: results of a tree-structured survival analysis. J Clin Oncol 8:963–977.PubMedGoogle Scholar
  8. 8.
    Lyman G, Dale D, Crawford J. 2003; Incidence and predictors of low dose-intensity in adjuvant breast cancer chemotherapy: a nationwide study of community practices. J Clin Oncol 21: 4524–4531.PubMedCrossRefGoogle Scholar
  9. 9.
    Lyman G, Dale D, Friedberg J, Crawford J, Risher R. 2004; Incidence and predictors of low chemotherapy dose-intensity in aggressive non-Hodgkin’s lymphoma: a nationwide study. J Clin Oncol 22:4302–4311.PubMedCrossRefGoogle Scholar
  10. 10.
    Moon S, Williams S, Cullen M. 2006; Role of prophylactic antibiotics in the prevention of infection after chemotherapy: a literature review. Support Cancer Ther 3:207–213.PubMedCrossRefGoogle Scholar
  11. 11.
    Gafter-Gvili A, Fraser A, Mical P, Leibovici L. 2005; Meta-analysis: antibiotic prophylaxis reduces mortality in neutropenic patients. Ann Intern Med 142:979–995.PubMedGoogle Scholar
  12. 12.
    Bucaneve G, Micozzi A, Menichetti F, Martino P, Dionisi M, Martinelli G, Allione B, D’Antonio D, Buelli M, Nosari M, Cilloni D, Zuffa E, Cantaffa R, Specchia G, Amadori S, Fabbiano F, Deliliers G, Lauria F, Foa, RDel Favero A, 2005; the Gruppo Italiano Malattie Ematologiche dell’Adulto (GIMEMA) Infection Program. Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia. N Engl J Med 353:977–987.PubMedCrossRefGoogle Scholar
  13. 13.
    Cullen M, Steven N, Billingham L, Gaunt C, Hastings M, Simmonds P, Stuart N, Rea D, Bower M, Fernando I, Hudddart R, Gollins S, Stanley A. 2005; Simple investigation in neutropenic individuals of the frequency of infection after chemotherapy +⁄− antibiotic in a number of tumours (SIGNIFICANT) Trial Group N Engl J Med353:988–998.PubMedCrossRefGoogle Scholar
  14. 14.
    Tjan-Heijnen VCG, Postmus P, Ardizzoni A, Manegold C, Burghouts J, van Meerbeeck J, Gans S, Mollers M, Buccholz E, Biesma B, Legrand C, Debruyne C, Giaccone G. 2001; Reduction of chemotherapy-induced febrile leucopenia by prophylactic use of ciprofloxacin and roxithromycin in small-cell lung cancer patients: an EORTC double-blind placebo-controlled phase III study. Ann Oncol 12:1359–1368.PubMedCrossRefGoogle Scholar
  15. 15.
    Timmer-Bonte J, de Boo T, Smit H, Biesma B, Wischut F, Cheragwandi S, Termeer A, Hensing C, Akkermans J, Adang E, Bootsma G, Tjan-Heijnen V. 2005; Prevention of chemotherapy-induced febrile neutropenia by prophylactic antibiotics plus or minus granulocyte colony-stimulating factor in small-cell lung cancer: a Dutch randomized phase III study. J Clin Oncol 23:7974–7984.PubMedCrossRefGoogle Scholar
  16. 16. . .
    Crawford J, Ozer H, Stoller R, Johnson D, Lyman G, Tabbara I, Kris M, Grous V, Picozzi V, Rausch G, et al. 1991; Reduction by granulocyte colony-stimulating factor of fever and neutropenia induced by chemotherapy in patients with small-cell lung cancer N Engl J Med 325:164–170.PubMedCrossRefGoogle Scholar
  17. 17.
    Trillet-Lenoir V, Green J, Manegold C, Von Pawel J, Gatzemeier U, Lebeau B, Depierre A, Johnson P, Decaster G, Tomita D, et al. 1993; . Recombinant granulocyte colony-stimulating factor reduces the infectious complications of cytotoxic chemotherapy Eur J Cancer 16A:319–324.CrossRefGoogle Scholar
  18. 18.
    Pettengell R, Gurney H, Radford JA, Deakin DP, James R, Wilkinson PM, Kane K, Bentley J, Crowther D. 1992; Granulocyte colony-stimulating factor to prevent dose-limiting neutropenia in non-Hodgkin’s lymphoma: a randomized controlled trial. Blood 80:1430–1436.PubMedGoogle Scholar
  19. 19.
    Blackwell S, Crawford J. 1994; G-CSF in the chemotherapy setting. In: . Morstyn, G. Granulocyte Colony-Stimulating Factor in the ClinicalMarcel Dekker, New York: 103–116.Google Scholar
  20. 20.
    Holmes FA, O’Shaughnessy JA, Vukelja S, Jones SE, Shgan J, Savin M, Glaspy J, Moore M, Meza L, Wiznitzer I, Neumann TA, Hill LR, Liang BC. 2002; Blinded, randomized, multicenter study to evaluate single administration pegfilgrastim once per cycle versus daily filgrastim as an adjunct to chemotherapy in patients with high-risk stage II or stage III/IV breast cancer J Clin Oncol 20:727–731.PubMedCrossRefGoogle Scholar
  21. 21.
    Green MD, Koelbl H, Baselga J, Galid A, Guillem V, Gascon P, Siena S, Lalisang RI, Samonigg H, Clemens MR, Zani V, Liang BC, Renwick J, Piccart MJ. 2003; A randomized double-blind multicenter phase III study of fixed-dose single-administration pegfilgrastim versus daily filgrastim in patients receiving myelosuppressive chemotherapy. Ann Oncol 14:29–35.PubMedCrossRefGoogle Scholar
  22. 22.
    ASCO 2006 Update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline.Google Scholar
  23. 23.
    Lyman G, Kuderer N, Djulbegovic B. 2002; Prophylactic granulocyte colony-stimulating factor in patients receiving dose-intensive cancer chemotherapy: a meta-analysis. American Journal of Medicine 112:406–411.PubMedCrossRefGoogle Scholar
  24. 24.
    National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology. Myeloid Growth Factors. V.1.2007.Google Scholar
  25. 25.
    Lyman G: 2003; Risk assessment in oncology clinical practice: from risk factors to risk models. Oncology 17:8–13.PubMedGoogle Scholar

Copyright information

© Humana Press, a part of Springer Science + Business Media, LLC 2009

Authors and Affiliations

  1. 1.Division of Medical OncologyDuke University Medical CenterDurham

Personalised recommendations