Abstract

Background:Current guidelines do not recommend G-CSF for patients with risk factors for neutropenia.Material/Methods: One-hundred patients undergoing chemotherapy were randomized to treatment with G-CSF at 5 Kg/kg for established febrile neutropenia (ANC <1000/micro l) (Group A) or G-CSF at 263 Kg/day if ANC was 1500/micro l or less on the day of the expected nadir, with the duration of treatment determined by the severity of neutropenia (Group B).
Results: The number of doses of G-CSF was similar in the two groups. There were 34 cases of febrile neutropenia in Group A, but none in Group B (p=0.0001). Hospital admission for febrile neutropenia, antibiotic use and delays in chemotherapy were all significantly more common in Group A. Total direct costs were estimated to be € 66, 646 for Group A and € 47, 119 for Group B.
Conclusions: Tailoring treatment does not increase G-CSF use, but significantly reduces febrile neutropenia and treatment delays and lowers direct costs.

Keywords: Antineoplastic Combined Chemotherapy Protocols - administration & dosage, Antineoplastic Combined Chemotherapy Protocols - economics, Drug Administration Schedule, Fever - blood, Fever - complications, Fever - drug therapy, Granulocyte Colony-Stimulating Factor - administration & dosage, Granulocyte Colony-Stimulating Factor - economics, Leukocyte Count, Neoplasms - blood, Neoplasms - complications, Neoplasms - drug therapy, Neutropenia - blood, Neutropenia - complications, Neutropenia - drug therapy, Neutrophils - cytology, Neutrophils - drug effects, Antineoplastic Combined Chemotherapy Protocols - economics, Drug Administration Schedule, Fever - drug therapy, Granulocyte Colony-Stimulating Factor - economics, Leukocyte Count, Neoplasms - drug therapy, Neutropenia - drug therapy, Neutrophils - drug effects