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Abiy Agiro, Andrea DeVries, Jennifer Malin and Michael J. Fisch

Factors recommend febrile neutropenia (FN) prophylaxis using a colony-stimulating factor (CSF) when risk, based on the chemotherapy regimen and patient risk factors, is “high” (>20%). 7 CSF prophylaxis may also be considered based on patient risk factors

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Gary H. Lyman and David C. Dale

granulocyte colony-stimulating factor (G-CSF). This article focuses on the long-term benefits and risks associated with G-CSF therapy, including data for other myeloid factors, as available. Chemotherapy-Induced Neutropenia G-CSF reduces neutropenic

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Leila Family, Yanli Li, Lie Hong Chen, John H. Page, Zandra K. Klippel and Chun Chao

, chemotherapy agents, or cycle length; (2) received prophylactic granulocyte colony-stimulating factor (G-CSF) within 4 days of chemotherapy initiation and/or antibiotics prophylaxis dispensed between 3 days before and 10 days after first chemotherapy

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Gary H. Lyman and Jessica Malone Kleiner

– 4311 . 7. Crawford J Ozer H Stoller R . Reduction by granulocyte colony-stimulating factor of fever and neutropenia induced by chemotherapy in patients with small-cell lung cancer . N Engl J Med 1991 ; 325 : 164 – 170 . 8

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Gary H. Lyman

neutropenia hospitalization associated with chemotherapy . Cancer 2005 ; 103 : 1916 – 1924 . 4 Lyman GH Kuderer NM . The economics of the colony-stimulating factors for the prevention and treatment of febrile neutropenia . Crit Rev Oncol

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Gary H. Lyman and Marek S. Poniewierski

treatment delays, and subsequently compromise disease control and overall survival. 2 – 6 The myeloid growth factors (MGFs), including granulocyte colony-stimulating factor (G-CSF), have been shown to decrease the risk of neutropenic complications

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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, and overall health care costs. In 2013, an interdisciplinary group at TCI implemented a QI project to reduce inappropriate PP pGCSF in patients with lung cancer; this included prescriber education and modification of chemotherapy orders by risk of FN in the electronic medical record (EMR). Inappropriate pGCSF was reduced from 28% to 4%. In this 5-year follow up study we analyzed pGCSF use in lung cancer patients. Methods: We conducted a review of lung cancer patients who received pGCSF with chemotherapy initiated between January 2016 and August 2018. PP pGCSF use was appropriate if prescribed with chemotherapy regimens with a high risk (>20%) for FN, or intermediate risk (10%–20%) if other accepted FN risk factors were present. PP use with FN low-risk (<10%) chemotherapy was considered inappropriate. Treating physicians were anonymously surveyed about their practices. Results: 294 patients with lung cancer received 1,353 doses of pGCSF during the study period. 58 (20%) were treated at TCI by subspecialty thoracic oncologists and 236 (80%) were treated at regional network sites. 100/294 (34%) patients received low-risk regimens. 62/100 (62%) patients treated with low-risk regimens received 311 doses of PP pGCSF (inappropriate use). 5/62 (8%) of inappropriate use occurred at TCI; 57/62 (92%) at network sites. Of 130 patients who received an intermediate risk regimen, 99 (76%) received PP pGCSF. At least one risk factor for FN was identified in 80/99 (80%) of these patients; age >65 and prior chemotherapy or radiation were the top-cited factors. 33/294 (11%) patients were hospitalized for FN during the study period; 7/100 (7%) received low-risk regimens, 15/130 (11.5%) intermediate-risk, and 11/46 (24%) high-risk regimens. All physicians responding to the survey indicated awareness of guidelines and EMR risk identification. Conclusion: After initial success at our center, we found that guideline-based alignment of pGCSF prescribing in lung cancer patients was not sustained. Despite reported familiarity with guidelines for PP pGCSF use, this analysis suggests an opportunity for re-education and further EMR modification. Based on July 2018 CMS average sales price, reduction in inappropriate use presents a potential cost savings of $1.5 million during the study.

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Lee S. Schwartzberg and Sarah L. Blair

: AC, anthracycline/cyclophosphamide; CMF, cyclophosphamide/methotrexate/fluorouracil; doc, docetaxel; G-CSF, granulocyte colony-stimulating factor; pts, patients; T, paclitaxel; TC, docetaxel/cyclophosphamide; TCH, docetaxel

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Olga Frankfurt and Martin S. Tallman

; 11 : 466 – 478 . 3. Lieschke GJ Grail D Hodgson G . Mice lacking granulocyte colony-stimulating factor have chronic neutropenia, granulocyte and macrophage progenitor cell deficiency, and impaired neutrophil mobilization . Blood 1994

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David C. Dale

colony-stimulating factor on the neutrophil response and peripheral blood colony-forming cells in healthy young and elderly adult volunteers . Blood 1994 ; 84 : 2923 – 2929 . 7 Price TH Chatta GS Dale DC . Effect of recombinant granulocyte