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Impact of Recombinant Granulocyte Colony-Stimulating Factor During Neoadjuvant Therapy on Outcomes of Resected Pancreatic Cancer

Pranav Murthy, Mazen S. Zenati, Samer S. AlMasri, Annissa DeSilva, Aatur D. Singhi, Alessandro Paniccia, Kenneth K. Lee, Richard L. Simmons, Nathan Bahary, Michael T. Lotze, and Amer H. Zureikat

Background Neutropenia is a common adverse event associated with chemotherapy. Recombinant granulocyte colony-stimulating factor (G-CSF) boosts granulopoiesis and neutrophil maturation 1 , 2 and is approved by the FDA for patients with

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Long-Term Outcomes of Myeloid Growth Factor Treatment

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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A Study of Novel Febrile Neutropenia Risk Factors Related to Bone Marrow or Immune Suppression, Barrier Function, and Bacterial Flora

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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BBCIC Research Network Analysis of First-Cycle Prophylactic G-CSF Use in Patients Treated With High–Neutropenia Risk Chemotherapy

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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Neutrophil Biology and the Next Generation of Myeloid Growth Factors

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

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A Patient Risk Model of Chemotherapy-Induced Febrile Neutropenia: Lessons Learned From the ANC Study Group

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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Outcomes and Predictors of 28-Day Mortality in Patients With Hematologic Malignancies and Septic Shock Defined by Sepsis-3 Criteria

Nirmala K. Manjappachar, John A. Cuenca, Claudia M. Ramírez, Mike Hernandez, Peyton Martin, Maria P. Reyes, Alba J. Heatter, Cristina Gutierrez, Nisha Rathi, Charles L. Sprung, Kristen J. Price, and Joseph L. Nates

; Hosmer-Lemeshow goodness-of-fit test, 7.03, df =8; P =.533; C-index = 0.795). Abbreviations: G-CSF, granulocyte colony-stimulating factor; OR, odds ratio; SOFA, sequential organ failure assessment score. Discussion In this study of a large

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Real-World Impact of Prophylactic Growth Factor Use on Timing of Febrile Neutropenia and Infection After High-Risk Chemotherapy

Douglas W. Blayney, Nicole M. Kuderer, Alice Kate Cummings Joyner, John Jarvis, Dominic Nunag, Jasmine Wells, Lan Huang, Ramon Monhanlal, and Gary H. Lyman

neutropenia. 1 To reduce the incidence of FN, NCCN recommends prophylactic treatment with granulocyte colony-stimulating factor (G-CSF) for adult patients with breast cancer who are at high risk of developing FN due to myelosuppressive chemotherapy. 2 Prior

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BPI19-015: Reduction of Inappropriate Prophylactic Pegylated Granulocyte Colony-Stimulating Factor (pGCSF) Use for Lung Cancer Patients: Five-Year Follow Up of a Quality Improvement (QI) Initiative at the Cleveland Clinic Taussig Cancer Institute (TCI)

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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Strategies for the Management of Early-Stage Breast Cancer in Older Women

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