Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update
- Study type
- Clinical guideline
- Study name
- ASCO WBC Growth Factors 2015
- Design
- Clinical practice guideline update based on a systematic review of randomised trials, meta-analyses and systematic reviews (October 2005 to September 2014)
- Source
- JCO · 2015
In plain words
Chemotherapy can lower the number of white blood cells and raise the risk of an infection with fever. Medicines that boost white blood cells (such as filgrastim) are used to prevent this side effect. According to this guideline, these medicines are usually recommended when the risk of fever with a low white cell count is about 20% or more. The treating doctor makes the final decision based on your age, medical history and type of chemotherapy.
Key points
Key guideline recommendations
Prophylactic use of CSFs to reduce the risk of febrile neutropenia is warranted when the risk of febrile neutropenia is approximately 20% or higher and no other equally effective and safe regimen that does not require CSFs is available.
Primary prophylaxis is recommended for the prevention of febrile neutropenia in patients at high risk based on age, medical history, disease characteristics and the myelotoxicity of the chemotherapy regimen.
Dose-dense regimens that require CSFs should be used only within an appropriately designed clinical trial or if supported by convincing efficacy data.
Prompt administration of CSFs is recommended for the management of patients exposed to lethal doses of total-body radiation, but not doses high enough to lead to certain death from injury to other organs.
Study population
This guideline addresses the use of haematopoietic colony-stimulating factors (CSFs) in patients receiving chemotherapy. The abstract specifies that recommendations on the use of CSFs in adult acute myeloid leukaemia and myelodysplastic syndromes were not reviewed in this update. Further details on the target population are given in the full text.
Endpoints
This paper is a guideline and has no trial endpoint. Its aim was to update the 2006 American Society of Clinical Oncology (ASCO) guideline on haematopoietic colony-stimulating factors.
Safety and side effects
The abstract gives no data on adverse events (grade 3 or higher). See the full text for safety details.
Clinical significance and place in guidelines
This guideline provides a framework for decisions on prevention of febrile neutropenia with CSFs. A risk threshold of approximately 20% or higher, when no equally effective regimen not requiring CSFs is available, is the main criterion. Use of CSFs with dose-dense regimens is recommended only within a clinical trial or with convincing efficacy data. The current status of these recommendations in newer guidelines should be checked separately, as the abstract concerns only this 2015 version.
Limitations
The abstract does not report the level of evidence or strength of the recommendations. Recommendations on adult acute myeloid leukaemia and myelodysplastic syndromes were not reviewed in this update. The evidence search extended to September 2014, so newer evidence and guidelines should be checked separately.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.