Guideline for Primary Prophylactic Administration

The ASCO guidelines note that the use of CSF has had little impact on empiric cure rate in patients with non-Hodgkin's lymphoma (NHL), SCLC, testicular cancer, or breast cancer. This finding reflects the lower incidence of febrile neutropenia in current regimes and the recognition in the 1990s that increasing chemotherapy dose intensity has not shown improvement in outcomes.

The guidelines conclude that for most chemotherapy regimes, primary administration is not recommended, but they do note that special circumstances exist. Special circumstances include patients who may be judged to be at high risk for the development of febrile neutropenia when there is demonstrated bone marrow compromise, comor-bidity, extensive previous chemotherapy or radiotherapy, poor performance status, or active tissue infection.

The recommendations by ESMO are similar and suggest that the use of CSFs is reasonable only if there is a greater than 40% probability of febrile neutropenia or if the dose reduction is deemed detrimental to outcome. The ESMO guidelines similarly note that special situations exist for the use of CSF for primary prophylaxis in patients who have had previous extensive chemotherapy or radiotherapy, HIV infection, poor performance status, or chemotherapy in the presence of active infection.

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