Aapro MS et al. (2006) EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphomas and solid tumours. Eur J Cancer 42: 2433–2453

Chemotherapy-induced neutropenia is a major risk factor for infection-related morbidity and mortality and an important dose-limiting toxicity in cancer treatment. The incidence of severe neutropenia or febrile neutropenia (FN) can be reduced by prophylactic treatment with granulocyte-colony stimulating factors (G-CSFs), but how such medication is used varies widely in clinical practice. The European Organisation for Research and Treatment of Cancer (EORTC) has recently produced guidelines for the use of G-CSF in adults with lymphomas and solid tumors undergoing chemotherapy.

Recommendations include the evaluation of patient-related adverse risk factors (e.g. age ≥65 years, advanced disease, previous history of FN) before each cycle of chemotherapy. Prophylactic G-CSF is recommended in chemotherapy regimens associated with FN in more than 20% of patients. For regimens associated with FN in 10–20% of patients, patient-related risk factors that could increase the overall risk of FN should be carefully assessed, and those patients with an overall individual risk of >20% for FN should also receive G-CSF. Prophylactic G-CSF support is also recommended in situations in which dose-dense or dose-intense chemotherapy strategies have survival benefits, and to support chemotherapy for which reductions in dose intensity or density are associated with a poor prognosis. Filgrastim, lenograstim and pegfilgrastim have all shown clinical efficacy and are all recommended for the prevention of FN or FN-related complications.