Impact of Primary Prophylaxis With Granulocyte Colony-Stimulating Factor on Febrile Neutropenia and Mortality in Adult Cancer Patients Receiving Chemotherapy: A Systematic Review
- Study type
- Meta-analysis
- Design
- Systematic review and meta-analysis of randomised controlled trials
- Sample size
- 17 randomised trials including 3493 patients
- Source
- JCO · 2007
In plain words
Drugs that boost the production of white blood cells (G-CSF) can be given alongside chemotherapy to prevent a dangerous drop in white blood cells with fever. This study pooled the results of 17 trials and showed that these drugs lower the chance of fever with low white blood cells and of early deaths, including deaths from infection. Patients were also able to receive chemotherapy doses closer to the original plan. The most common side effect was bone and muscle pain. It is still not clear whether these drugs help patients live longer.
Key results
Treatment arms and regimens
Primary prophylaxis with granulocyte colony-stimulating factor (G-CSF) alongside chemotherapy. Dose details in the full text of the paper.
Placebo or no treatment. In some studies the control group was allowed to receive secondary prophylaxis with G-CSF. Dose details in the full text of the paper.
Source of the regimen details: Abstract of the paper; the G-CSF dose and schedule are not given in the abstract (dose details in the full text of the paper)
Doses are given for the information of specialists, as in this study’s protocol, and are not a prescription. Every drug must be prescribed by the treating physician for the individual patient.
Study population
Adult patients with solid tumours and malignant lymphoma who, in randomised trials, received primary prophylaxis with G-CSF versus placebo or an untreated control group.
Endpoints
Outcomes assessed included infection-related mortality, early mortality (death from any cause during chemotherapy), febrile neutropenia (FN) and relative dose intensity (RDI). Bone or musculoskeletal pain was also assessed as an adverse effect. Disease-free survival and overall survival were also considered, but the data were insufficient to assess them.
Safety and side effects
Bone or musculoskeletal pain was reported in 19.6% of patients in the G-CSF group and 10.4% of the control group (RR = 4.03; 95% CI 2.15–7.52; P < 0.001). Other adverse event data are not given in the abstract.
Clinical significance and place in guidelines
This meta-analysis provides evidence that primary prophylactic G-CSF reduces FN and early mortality, including deaths from infection. An increase in RDI and in musculoskeletal pain was also reported. According to the abstract, the data are insufficient to judge the effect on disease-free survival and overall survival. The status of these findings in current clinical guidelines and the exact indications for use should be checked separately; they are not mentioned in the abstract.
Limitations
According to the abstract, the available data are insufficient to assess the effect of G-CSF on disease-free survival and overall survival. In some studies the control group was allowed secondary prophylaxis with G-CSF. Other details, such as heterogeneity between studies, cancer types and chemotherapy regimens, are not given in the abstract and should be checked in the full text.
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.