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Impact of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in adult cancer patients receiving chemotherapy: a systematic review.

Publication ,  Journal Article
Kuderer, NM; Dale, DC; Crawford, J; Lyman, GH
Published in: J Clin Oncol
July 20, 2007

PURPOSE: Randomized controlled trials (RCTs) of prophylactic granulocyte colony-stimulating factors (G-CSF) have demonstrated a significant reduction in febrile neutropenia (FN) after systemic chemotherapy. Several RCTs have been published recently that investigate the impact of G-CSF on mortality and relative dose-intensity (RDI). METHODS: A comprehensive systematic review and meta-analysis of all reported RCTs comparing primary prophylactic G-CSF with placebo or untreated controls in adult solid tumor and malignant lymphoma patients was undertaken without language restrictions, using electronic databases, conference proceedings, and hand-searching techniques. Two reviewers extracted data independently. Summary estimates of relative risk (RR) with 95% CIs were estimated based on the method of Mantel-Haenszel and DerSimonian and Laird. RESULTS: Seventeen RCTs were identified including 3,493 patients. For infection-related mortality, RR reduction with G-CSF compared with controls was 45% (RR = 0.55; 95% CI, 0.33 to 0.90; P = .018); for early mortality (all-cause mortality during chemotherapy period), it was 40% (RR = 0.60; 95% CI, 0.43 to 0.83; P = .002); and for FN, it was 46% (RR = 0.54; 95% CI, 0.43 to 0.67; P < .001). Average RDI was significantly higher in patients who received G-CSF compared with control patients (P < .001). Bone or musculoskeletal pain was reported in 10.4% of controls and 19.6% of G-CSF patients (RR = 4.03; 95% CI, 2.15 to 7.52; P < .001). Significant reductions in FN with G-CSF were observed in studies allowing secondary G-CSF prophylaxis in controls and in the three trials with concurrent prophylactic antibiotics in both treatment arms. CONCLUSION: Prophylactic G-CSF reduces the risk of FN and early deaths, including infection-related mortality, while increasing RDI and musculoskeletal pain. There are insufficient data to assess the impact of G-CSF on disease-free and overall survival.

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Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

July 20, 2007

Volume

25

Issue

21

Start / End Page

3158 / 3167

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Risk Assessment
  • Randomized Controlled Trials as Topic
  • Primary Prevention
  • Oncology & Carcinogenesis
  • Neutropenia
  • Neoplasms
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
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Kuderer, N. M., Dale, D. C., Crawford, J., & Lyman, G. H. (2007). Impact of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in adult cancer patients receiving chemotherapy: a systematic review. J Clin Oncol, 25(21), 3158–3167. https://doi.org/10.1200/JCO.2006.08.8823
Kuderer, Nicole M., David C. Dale, Jeffrey Crawford, and Gary H. Lyman. “Impact of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in adult cancer patients receiving chemotherapy: a systematic review.J Clin Oncol 25, no. 21 (July 20, 2007): 3158–67. https://doi.org/10.1200/JCO.2006.08.8823.
Kuderer, Nicole M., et al. “Impact of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in adult cancer patients receiving chemotherapy: a systematic review.J Clin Oncol, vol. 25, no. 21, July 2007, pp. 3158–67. Pubmed, doi:10.1200/JCO.2006.08.8823.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

July 20, 2007

Volume

25

Issue

21

Start / End Page

3158 / 3167

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Risk Assessment
  • Randomized Controlled Trials as Topic
  • Primary Prevention
  • Oncology & Carcinogenesis
  • Neutropenia
  • Neoplasms
  • Male
  • Humans