Document Detail


Impact of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in adult cancer patients receiving chemotherapy: a systematic review.
MedLine Citation:
PMID:  17634496     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Randomized controlled trials (RCTs) of prophylactic granulocyte colony-stimulating factors (G-CSF) have demonstrated a significant reduction in febrile neutropenia (FN) after systemic chemotherapy. Several RCTs have been published recently that investigate the impact of G-CSF on mortality and relative dose-intensity (RDI).
METHODS: A comprehensive systematic review and meta-analysis of all reported RCTs comparing primary prophylactic G-CSF with placebo or untreated controls in adult solid tumor and malignant lymphoma patients was undertaken without language restrictions, using electronic databases, conference proceedings, and hand-searching techniques. Two reviewers extracted data independently. Summary estimates of relative risk (RR) with 95% CIs were estimated based on the method of Mantel-Haenszel and DerSimonian and Laird.
RESULTS: Seventeen RCTs were identified including 3,493 patients. For infection-related mortality, RR reduction with G-CSF compared with controls was 45% (RR = 0.55; 95% CI, 0.33 to 0.90; P = .018); for early mortality (all-cause mortality during chemotherapy period), it was 40% (RR = 0.60; 95% CI, 0.43 to 0.83; P = .002); and for FN, it was 46% (RR = 0.54; 95% CI, 0.43 to 0.67; P < .001). Average RDI was significantly higher in patients who received G-CSF compared with control patients (P < .001). Bone or musculoskeletal pain was reported in 10.4% of controls and 19.6% of G-CSF patients (RR = 4.03; 95% CI, 2.15 to 7.52; P < .001). Significant reductions in FN with G-CSF were observed in studies allowing secondary G-CSF prophylaxis in controls and in the three trials with concurrent prophylactic antibiotics in both treatment arms.
CONCLUSION: Prophylactic G-CSF reduces the risk of FN and early deaths, including infection-related mortality, while increasing RDI and musculoskeletal pain. There are insufficient data to assess the impact of G-CSF on disease-free and overall survival.
Authors:
Nicole M Kuderer; David C Dale; Jeffrey Crawford; Gary H Lyman
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Journal of clinical oncology : official journal of the American Society of Clinical Oncology     Volume:  25     ISSN:  1527-7755     ISO Abbreviation:  J. Clin. Oncol.     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-07-19     Completed Date:  2007-08-22     Revised Date:  2011-01-03    
Medline Journal Info:
Nlm Unique ID:  8309333     Medline TA:  J Clin Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3158-67     Citation Subset:  IM    
Affiliation:
University of Rochester School of Medicine and Dentistry, James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY 14642, USA. Nicole_Kuderer@urmc.rochester.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Antineoplastic Combined Chemotherapy Protocols / adverse effects*,  therapeutic use
Cause of Death*
Dose-Response Relationship, Drug
Drug Administration Schedule
Female
Fever / chemically induced,  prevention & control
Follow-Up Studies
Granulocyte-Macrophage Colony-Stimulating Factor / administration & dosage*
Humans
Male
Neoplasms / drug therapy*,  mortality*,  pathology
Neutropenia / chemically induced,  prevention & control*
Primary Prevention / methods
Randomized Controlled Trials as Topic
Risk Assessment
Survival Analysis
Treatment Outcome
Grant Support
ID/Acronym/Agency:
T32HL07152-30/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
83869-56-1/Granulocyte-Macrophage Colony-Stimulating Factor
Comments/Corrections
Comment In:
J Clin Oncol. 2010 Dec 20;28(36):e762-3; author reply e764   [PMID:  21079143 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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