Background: Granulocyte colony-stimulating factor (G-CSF) prophylaxis has been shown to reduce the risk and duration of chemotherapy-induced neutropenia and febrile neutropenia (FN) and is recommended for at-risk patients receiving chemotherapy. Within the South Texas Veterans Health Care System (STVHCS), daily filgrastim injections remain the preferred formulation of G-CSF for primary prophylaxis of FN. Methods: This retrospective, single-center cohort study from September 2015 to September 2020 included 59 patients who received daily filgrastim as primary prophylaxis with a curative cancer diagnosis and a chemotherapy regimen. Patients had either a high risk for FN or a chemotherapy regimen with an intermediate risk for FN and additional risk factors. The primary outcome was the incidence of neutropenia/FN leading to treatment delays. Secondary outcomes included chemotherapy dose decreases or discontinuations, hospitalizations, days of hospitalization, infections, extended duration of filgrastim, and transitions to pegfilgrastim due to neutropenia/FN. Results: Patients received a median (IQR) of 7 (5-10) doses of filgrastim for primary prophylaxis. Overall, 10 (17%) patients experienced treatment delays due to neutropenia/FN. Fifteen (25%) patients were hospitalized with a median (IQR) length of stay of 5 (4-7) days, 9 (15%) patients had documented infections, and 2 (3%) patients required a chemotherapy dose reduction. Additionally, 9 (15%) patients required an additional median (IQR) of 2 (2-5) doses of filgrastim, and 9 (15%) patients were transitioned to pegfilgrastim. Conclusions: These results suggest that additional measures such as tracking postnadir absolute neutrophil counts should be performed to ensure patients receive an appropriate number of filgrastim doses to prevent complications associated with neutropenia/FN.
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