Treatment for Adult Patients
➤ Dose-dense regimens with CSF support should be used only if
supported by convincing efficacy data or within an appropriately
designed clinical trial. Efficacy data support the use of dose-dense
chemotherapy in the adjuvant treatment of high-risk breast cancer
and the use of high-dose intensity methotrexate, vinblastine,
doxorubicin, and cisplatin in urothelial cancer. There are limited
and conflicting data on the value of dose-dense regimens with
CSF support in non-Hodgkin lymphoma, and it cannot routinely be
recommended at this time. (Strong Recommendation; EB-B-H [for
breast cancer and lymphoma]; Moderate Recommendation; EB-B-I
[for urothelial cancer]).
➤ CSFs may be used alone, after chemotherapy, or in combination with
plerixafor to mobilize peripheral-blood progenitor cells. Choice of
mobilization strategy depends in part on type of cancer and type of
transplantation. (Strong Recommendation; EB-B-H)
➤ CSFs should be administered after autologous stem-cell
transplantation to reduce the duration of severe neutropenia.
(Strong Recommendation; EB-B-H)
➤ CSFs may be administered after allogeneic stem-cell
transplantation to reduce the duration of severe neutropenia.
(Weak Recommendation; EB-L).
➤ Prophylactic CSFs for patients with diffuse aggressive
lymphoma age ≥ 65 years treated with curative chemotherapy
(cyclophosphamide, doxorubicin, vincristine, prednisone, and
rituximab) should be considered, particularly in the presence of
comorbidities. (Moderate Recommendation; EB-B-I)
➤ Pegfilgrastim, filgrastim, tbo-filgrastim, and filgrastim-sndz (and
other biosimilars, as they become available) can be used for the
prevention of treatment-related febrile neutropenia. The choice of
agent depends on convenience, cost, and clinical situation. There
have been no additional data comparing granulocyte CSFs and
granulocyte-macrophage CSFs since the 2006 update. Therefore,
there is no change in the recommendation regarding their
therapeutic equivalency. (Strong Recommendation; EB-B-H)
➤ 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 resulting from injury to other
organs, include the prompt administration of CSFs or pegylated
granulocyte CSFs. (Moderate Recommendation; FC [by others] B-I)
