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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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Pamala A. Pawloski, Cara L. McDermott, James H. Marshall, Vanita Pindolia, Catherine M. Lockhart, Catherine A. Panozzo, Jeffrey S. Brown, and Bernadette Eichelberger

Background Prophylaxis with the recombinant human granulocyte colony-stimulating factors (G-CSFs) filgrastim and pegfilgrastim prevents chemotherapy-induced neutropenia; reduces febrile neutropenia (FN) risk and infection-related and early

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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