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Huntsman Cancer Institute at the University of Utah

Chemotherapy-induced neutropenia can cause complications that result in dose reductions or treatment delays that can, in turn, compromise clinical outcomes. Although the prophylactic use of colony-stimulating factors (CSFs) can reduce the risk, severity, and duration of severe and febrile neutropenia, they are not routinely administered to all patients undergoing myelosuppressive chemotherapy because of the costs. Selective use may, however, enhance their cost-effectiveness. These guidelines discuss the preventative or prophylactic use of recombinant human granulocyte-CSF to reduce the incidence, length, and severity of chemotherapy-related neutropenia and and prevent life-threatening complications.

For the most recent version of the guidelines, please visit NCCN.org

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Tarek Haykal, Babikir Kheiri, Varun Samji, Yazan Zayed, Ragheed Al-Dulaimi, Inderdeep Gakhal, Areeg Bala, Jason Sotzen, Ahmed Abdalla and Ghassan Bachuwa

lipase, 6%; neutropenia, 6%; thrombocytopenia, 6%; hypophosphatemia, 5%; lymphocytopenia, 5%; anemia, 4%; and leukopenia, 3%. Conclusion: Despite s unitinib being one of the current standard treatments for patients with metastatic/advanced clear

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Anne K. Hubben, Nathan Pennell, Marc Shapiro, Craig Savage and James P. Stevenson

Purpose: National guidelines do not include routine pGCSF as primary prophylaxis (PP) for patients receiving chemotherapy associated with a low risk for febrile neutropenia (FN). Inappropriate pGCSF can increase patient morbidity, financial burden

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Juliana E. Hidalgo Lopez, Mariko Yabe, Adrian A. Carballo-Zarate, Sa A. Wang, Jeffrey L. Jorgensen, Sairah Ahmed, John Lee, Shaoying Li, Ellen Schlette, Timothy McDonnell, Roberto N. Miranda, L. Jeffrey Medeiros, Carlos E. Bueso-Ramos and C. Cameron Yin

T-cell large granular lymphocytic (T-LGL) leukemia is an indolent neoplasm characterized by a persistent (>6 months) increase in peripheral blood LGLs, usually between 2 and 20 × 10 9 /L. 1 Patients often present with neutropenia, splenomegaly

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Memorial Sloan-Kettering Cancer Center

Infectious diseases are important causes of morbidity and mortality in patients with cancer. In certain instances, the malignancy itself can predispose patients to severe or recurrent infections. Neutropenia has been recognized for many decades as a major risk factor, and effective strategies to anticipate, prevent, and manage infectious complications in patients with cancer experiencing neutropenia have led to improved outcomes. Reflecting the heterogeneity of immunocompromised conditions in patients with cancer and the spectrum of pathogens to which they are susceptible, NCCN expanded the scope of the Fever and Neutropenia Panel in 2007 to create guidelines on Prevention and Treatment of Cancer-Related Infections. These guidelines, newly updated for 2008, characterize major categories of immunologic deficits in persons with cancer and the major pathogens to which they are susceptible.

For the most recent version of the guidelines, please visit NCCN.org

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Chemotherapy-induced neutropenia is the major dose-limiting toxicity of systemic cancer chemotherapy, associated with substantial morbidity, mortality, and cost. Although prophylactic colony-stimulating factors (CSFs), can reduce this complication, their routine use in all patients on myelosuppressive chemotherapy is prohibitively costly. Selective use in patients most at risk for neutropenia may enhance cost-effectiveness, but determining the actual risk is complicated by issues in reporting myelosuppression and dose intensity, among other factors. For this reason, NCCN experts developed these guidelines to assist practitioners in the appropriate prophylactic use of CSFs.

For the most recent version of the guidelines, please visit NCCN.org

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Jing Xi, Aabha Oza, Shana Thomas, Foluso Ademuyiwa, Katherine Weilbaecher, Rama Suresh, Ron Bose, Mathew Cherian, Leonel Hernandez-Aya, Ashley Frith, Lindsay Peterson, Jingqin Luo, Jairam Krishnamurthy and Cynthia X. Ma

neutropenia were collected and graded according to NCI Common Terminology Criteria for Adverse Events, version 4.1. Grade 1 neutropenia occurred in 15.5% of the patients (n=31), grade 2 in 31.5% (n=63), grade 3 in 38.5% (n=77), and grade 4 in 3% (n=6). Dose

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Rodger J. Winn

The Myeloid Growth Factors guidelines in this month's issue are in some ways a paradigm for successful guidelines—guidelines that support clinical decision-making. The algorithm comes down to the level of actual administration, with specific thresholds for beginning, dosages, and stopping. This granularity is possible, of course, because of the extraordinary number of trials meticulously designed to answer specific drug-related questions. For example, Frankfurt and Tallman's article on using these agents in leukemia describes trials that have investigated not only the efficacy of these stimulating factors but also their potential deleterious effects. I'm reassured to learn from Lyman and Kleiner of the consistency found across 3 well-known guidelines for these agents. A major recommendation in all 3 guidelines is that growth factors be initiated for primary prophylaxis if the expected rate of febrile neutropenia is 20%. This new threshold varies considerably from the initial American Society of Clinical Oncology (ASCO) guidelines in 1994, which used a 40% threshold. The new mark is based on results from several randomized clinical trials and meta-analyses that confirm the efficacy of these agents in significantly diminishing the incidence of febrile neutropenia at this level. In what will likely become a major issue for guidelines developers in the future, economic considerations emerged in these discussions. Although NCCN and ASCO state that decisions were based on proven clinical benefit, both groups acknowledge the potentially large economic impact that using these agents may have—both their capacity to save in-hospital expenses and the financial burden they could impose if...
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-897 ), the first node in the “Yes” pathway for “Significant concerns about alopecia or neutropenia” should have read, “Platinum/ pemetrexed + bevacizumab” (page 894). The editorial office apologizes for this error. A corrected copy of the editorial is

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Jeffrey Crawford

, the NCCN Guidelines Panel initially established the febrile neutropenia threshold for use of myeloid growth factors at 20%; this standard has now been adopted by virtually all other guidelines committees. Moreover, it was the NCCN Panel who stressed