ASCO GUIDELINES Bundle

WBC Growth Factors

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Key Points ➤ Prophylactic use of colony-stimulating factors (CSFs) to reduce the risk of febrile neutropenia is warranted when the risk of febrile neutropenia is approximately 20% or higher and no other equally effective and safe regimen that does not require CSFs is available. ➤ Primary prophylaxis is recommended for the prevention of febrile neutropenia in patients who are at high risk on the basis of age, medical history, disease characteristics, and myelotoxicity of the chemotherapy regimen. ➤ Dose-dense regimens that require CSFs should be used only within an appropriately designed clinical trial or if supported by convincing efficacy data. ➤ Current recommendations for the management of patients exposed to lethal doses of total-body radiotherapy, but not doses high enough to lead to certain death as a result of injury to other organs, include the prompt administration of CSFs. Diagnosis Table 1. Patient Risk Factors for Febrile Neutropenia In addition to chemotherapy regimen and type of malignancy, consider the following factors when estimating patient's overall risk of febrile neutropenia. • Age ≥65 years • Poor performance status or poor nutritional status • Advanced disease • Poor renal function • Previous chemotherapy or radiation therapy • Liver dysfunction, most notably elevated bilirubin • Preexisting neutropenia or bone marrow involvement with tumor • Infection • Cardiovascular disease • Multiple comorbid conditions • Open wounds or recent surgery • HIV infection

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