Guidelines for the use of granulocyte colony-stimulating growth factors in oncology

Neutropenia and febrile neutropenia (FN) may result in chemotherapy dosing delay and/or reduction, thereby impacting the disease course and patient outcomes. FN is associated with increased mortality rates; up to 9.5% of deaths have been observed following hospital admission for FN. Granulocyte-colony stimulating factors (G-CSF) provide great contribution in the prevention of chemotherapy-induced neutropenia. G-CSF prophylaxis shortens the duration of chemotherapy-induced neutropenia, resulting in a decreased incidence of FN, hospitalization, and use of intravenous therapeutic antibiotics by approximately 50%. However, adverse effects, sometimes deleterious, may occur in some cases. At the time of decision-making regarding any preventive treatment by G-CSF, in addition to the elaboration of an optimal chemotherapeutic protocol, oncologists have to take into account also both the individual risk factors of the patient and the therapeutic goals. The treatment is expected to be curative, symptomatic and even palliative, and to extend the survival in case of advanced stage disease. Consequently, recommendations regarding the use of G-CSF have been addressed by most international cancer societies.