Journal of Clinical Oncology (07/15) Smith, Thomas J.; Bohlke, Kari; Lyman, Gary H.

The American Society of Clinical Oncology (ASCO) has updated its 2006 guideline on the use of hematopoietic colony-stimulating factors (CSFs). The Update Committee conducted a systematic review of randomized clinical trials, meta-analyses, and systematic reviews from October 2005 through September 2014. Changes to the guidelines include the addition of tbo-filgrastim and filgrastim-sndz, moderation of the recommendation regarding routine use of CSFs in older patients with diffuse aggressive lymphoma, and the addition of recommendations against routine dose-dense chemotherapy in lymphoma and for high–dose-intensity chemotherapy in urothelial cancer. The recommendations state that prophylactic use of CSFs to reduce the risk of febrile neutropenia is warranted when the risk of febrile neutropenia is about 20 percent or higher and no other equally effective and safe regimen that does not require CSFs is available. In addition, the ASCO recommends primary prophylaxis for the prevention of febrile neutropenia in patients who are at high risk based on their age, medical history, disease characteristics, and myelotoxicity of the chemotherapy regimen. Dose-dense regimens that require CSFs should only be used within an appropriately designed clinical trial or if supported by convincing efficacy data. The ASCO also notes that current recommendations for helping patients exposed to lethal doses of total-body radiotherapy, though not high enough doses to lead to certain death from injury to other organs, call for the prompt administration of CSFs.

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