Hematology/Oncology Clinical Practice Guidelines: 2018 Midyear Review

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO

Disclosures

July 09, 2018

In This Article

Myeloid Growth Factors

National Comprehensive Cancer Network

Myeloid growth factors (MGFs) are given as supportive care to patients receiving myelosuppressive chemotherapy to reduce the incidence of neutropenia. Neutropenia is defined as an absolute neutrophil count (ANC) of <500 neutrophils/mcL or an ANC of <1,000 neutrophils/mcL and a predicted decline ≤500 neutrophils/mcL over the next 48 hours.

The NCCN Guidelines recommend prophylactic use of MGFs if the risk of febrile neutropenia (FN) is >20%.

For low-risk patients, as defined by risk less than 10%, routine use of MGF is not recommended, as alternative treatment options are appropriate and more cost-effective.

The NCCN Panel defines intermediate risk as a 10% to 20% probability of developing FN or a neutropenic event that would compromise treatment. The panel recommends individualized consideration of MGFs based on physician–patient discussion of the risk/benefit ratio with respect to the likelihood of developing FN, the potential consequences of a neutropenic event, and the implications of reduced chemotherapy dose delivery.

MGFs can be used in the supportive care of patients receiving myelosuppressive chemotherapy to prevent severe complications, such as FN and associated infections, and improve overall quality of life.

These NCCN Guidelines focus on the 2 MGFs that have shown the most promise in terms of clinical use: granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF).

Filgrastim, filgrastim-sndz, tbo-filgrastim, and pegfilgrastim are G-CSFs currently approved by the FDA for the prevention of chemotherapy-induced neutropenia. The only GM-CSF that is FDA-approved is sargramostim.

Prophylactic use of MGFs has been shown to reduce the risk, severity, and duration of chemotherapy-related FN in a variety of cancers. The risk of developing FN is related to the treatment regimen and delivered dose intensity, as well as individual patient risk factors, such as increased age (>65 years), comorbidities including renal or liver dysfunction, and preexisting infections.

Because development of FN can prompt dose reductions or treatment delays, use of MGFs can help ensure the delivery of full dose-intensity chemotherapy on schedule, resulting in improved clinical outcome. However, associated costs have prevented their routine use in all patients receiving myelosuppressive chemotherapy.

Reference

  • Crawford J, Becker PS, Armitage JO, et al. Myeloid Growth Factors, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2017 Dec;15(12):1520-41. http://www.jnccn.org/content/15/12/1520.long

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