What’s New in JCO
2006 Update of ASCO Practice Guideline Recommendations for the Use of White Blood Cell Growth Factors: Guideline Summary
ASCO convened an Update Committee composed of the original Expert Panel and select ad hoc members to present the 2006 evidence-based clinical practice guideline update (J Clin Oncol 24:3187-3205, 2006) for the use of hematopoieticcolony-stimulating factors (CSF).
4. Use of CSF to Increase Chemotherapy Dose Intensity and Dose Density
Data on using CSF to increase dose-intensity or -density chemotherapy regimens are limited. Evidence has shown that the use of CSF allows for a moderate increase in dose-dense (but not dose-intense) regimens in certain settings (e.g., nodepositive breast cancer; and possibly non-Hodgkin’s lymphoma pendingconﬁrmation of results of individual trials). This treatment approach should only be used within the constructs of a clinical trial or if supported by appropriate evidence.
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Updated 2006 RecommendationsSee Table 1 for a summary of the updated 2006 recommendations and speciﬁc considerations. Table A1 lists the incidence of toxicities associated with selected chemotherapy regimens.
1. Primary Prophylactic CSF Administration (ﬁrst and subsequent-cycle use)
Clinical trial data support the use of CSF when the risk of febrile neutropenia (FN) is in the range of 20% or higher. This recommendationrepresents a departure from the 2000 update, which recommended the use of CSF when the risk of FN was 40% or higher. Most commonly used regimens have an FN risk of less than 20%. Oncologists should consider the optimal chemotherapy regimen, individual patient risk factors and treatment intention when deciding whether to use prophylactic CSF. The use of regimens that do not require CSF because ofequal efﬁcacy and lower risk of FN remains standard medical practice.
5. Use of CSF As Adjuncts to ProgenitorCell Transplantation
Major complications of high-dose chemotherapy supported by autologous bone marrow transplantation or peripheralblood progenitor cell (PBPC) transplantation include disease recurrence, infection, delayed or incomplete engraftment, and organ damage from the ablativeregimen. The use of CSF to mobilize PBPC and to shorten the period of neutropenia after cytoreduction and PBPC transplantation is well established.
6. Use of CSF in Patients With Acute Leukemia and Myelodysplastic Syndromes
Considerations and available evidence vary for acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), acute lymphocytic leukemia (ALL), and acute leukemia in relapse.Several studies have shown that CSF administration can produce modest decreases in the duration of neutropenia when begun shortly after completion of the initial induction chemotherapy for patients with AML. Studies on CSF priming of leukemia cells in patients with AML produced results showing no effect on complete response rates or overall survival. Additional studies on AML patients (those inremission) showed a seemingly profound shortened duration of neutropenia after consolidation chemotherapy. These studies produced no effect on complete response duration or overall patient survival. Though CSF use can increase the absolute neutrophil count in neutropenic patients with MDS, data supporting the routine, long-term, continuous use of CSF for this population are lacking. Using CSF forpatients with ALL (after initial chemotherapy induction or postremission course) may shorten the duration of neutropenia by 1 week. However, CSF use in patients with relapsed or refractory acute leukemia may provide only a few days of shortened neutropenia.
Copyright © 2006 by American Society of Clinical Oncology. All rights reserved.
2. Secondary Prophylactic CSF Administration
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