During the past several years, a number of novel targeted anticancer drugs have been integrated into clinical practice. Despite the efficacy and variety of new agents, traditional myelosuppressive chemotherapy remains the backbone of cancer treatment. In addition, the new biologicals often increase myelotoxicity when added to standard chemotherapy regimens.Therefore, myelosuppression remains the most common toxicity encountered in the oncology clinic today and this complication is likely to remain a serious problem indefinitely. Chemotherapy-induced neutropoenia (CIN) is defined clinically as an absolute neutrophil count (ANC) of <1.0x10 9 /l, at which point the risk of infection begins to rise. This risk is related both to the depth and duration of neutropoenia. 1 An ANC below 0.5x10 9 /l is therefore considered severe neutropoenia (SN) and febrile neutropoenia (FN) is defined as a temperature >38.2ºC on two determinations with an ANC <0.5x10 9 /l, which indicates a high likelihood of a localised or systemic infection. FN requires prompt intervention with broad spectrum antibiotics until endogenous recovery of the bone marrow occurs. Subsequent evaluation of the MASCC index has validated the prognostic accuracy of the score in other patient populations. 5 The tool has proven clinical utility in allowing patients at low risk to be treated successfully with oral antibiotics and be followed as outpatients. 6,7 Attempts to incorporate blood inflammatory marker analysis into the clinical scale did not add to the predictive value of the MASCC score. 8 A risk-adapted strategy utilising the MASCC index allows a significant fraction of low-risk patients to be treated in the outpatient setting when follow-up is careful and adherence to medical care is high. 9 Nonetheless, the majority of patients with FN do require at least some inpatient observation and treatment with intravenous antibiotics. The costs associated with FN and its treatment are substantial and are not limited to the direct cost of hospitalisations. It is likely that even separating out low-risk patients for outpatient treatment will not have a great impact on costs, which are driven mostly by the fraction of patients who have severe complications. 10 Health systems may therefore be obligated to expend increased resources caring for patients with FN.Risk of SN and FN from chemotherapy depends on several factors, most importantly the myelosuppressive intensity of the chemotherapy regimen utilised. One way to reduce the risk of CIN is to reduce the drug dosage delivered. However, substantial direct and retrospective evidence suggests that reduction in relative dose intensity is deleterious in terms of disease-free outcome and overall survival in the curative and perhaps life-prolonging indications for chemotherapy. 11,12 CIN is a common cause of chemotherapy dose delay and dose reduction, 13 and prolonged recovery from FN may compromise subsequent cycle delivery of full dose on schedule. Colony-stimulating Factors for Chemotherapy-induced NeutropoeniaAn alte...
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