➤ Primary prophylaxis with a CSF starting with the first cycle
and continuing through subsequent cycles of chemotherapy is
recommended in patients who have an approximately 20% or higher
risk for febrile neutropenia based on patient-, disease- and treatment-
related factors. Primary CSF prophylaxis should also be administered
in patients receiving dose-dense chemotherapy when considered
appropriate. Consideration should be given to alternative, equally
effective, and safe chemotherapy regimens not requiring CSF support
when available. (Strong Recommendation; EB-B-H) (See Table 1)
➤ Secondary prophylaxis with a CSF is recommended for patients
who experienced a neutropenic complication from a prior cycle of
chemotherapy (for which primary prophylaxis was not received), in
which a reduced dose or treatment delay may compromise disease-
free or overall survival or treatment outcome. In many clinical
situations, dose reduction or delay may be a reasonable alternative.
(Strong Recommendation; EB-B-H)
➤ CSFs should not be routinely used for patients with neutropenia who
are afebrile. (Strong Recommendation; EB-B-H)
➤ CSFs should not be routinely used as adjunctive treatment with antibiotic
therapy for patients with fever and neutropenia. However, CSFs should
be considered in patients with fever and neutropenia who are at high risk
for infection-associated complications or who have prognostic factors
predictive of poor clinical outcomes. (Strong Recommendation; EB-B-H)
(See Table 2)
Table 2. Patient Risk Factors for Poor Clinical Outcomes
Resulting From Febrile Neutropenia or lnfection
• Sepsis syndrome • Pneumonia
• Age >65 years • Invasive fungal infection
• Profound neutropenia
(absolute neutrophil count <0.1 × 10
9
/L)
• Other clinically documented infections
• Hospitalization at time of fever
• Neutropenia expected to last >10 days • Prior episode of febrile neutropenia
Treatment for Adult Patients
Diagnosis
