Prophylactic administration of granulocyte colony‐stimulating factor (filgrastim) after conventional chemotherapy in children with cancer

Abstract

We evaluated granulocyte colony-stimulating factor (G-CSF) as an adjunct to courses of conventional chemotherapy in 16 children with cancer. One course followed by G-CSF (20 episodes) was compared to identical courses without G-CSF (20 episodes) in the same patients. The mean duration of G-CSF therapy was 8.8 (5-13) days. The periods of neutropenia (4.8 days versus 16.5 days; p < 0.0001), days of hospitalization for febrile neutropenia (13 days versus 65 days; p = 0.02) and days on broad-spectrum antibiotics (13 days versus 95 days; p = 0.003) were significantly reduced. With the use of G-CSF the profound neutropenia could be prevented in 11 (55%) episodes. There were two episodes of fever and neutropenia in the G-CSF group as compared to 10 febrile neutropenias in the control group (p = 0.04). G-CSF was well tolerated and did not cause additional expenses when compared to the expenses needed for the treatment of febrile neutropenias. The cost benefit analyses showed that through using G-CSF a savings was realized in the amount of U.S. $20,650 for 20 cycles of chemotherapy, i.e., U.S. $1,033/chemotherapy cycle. We conclude that the use of G-CSF was efficacious and did not increase the total costs of therapy.

Granulocyte-colony stimulating factor and multiple cycles of strongly myelosuppressive alkylator-based combination chemotherapy in children with neuroblastoma

“…The reported effects of G-CSF or GM-CSF on chemotherapy-induced thrombocytopenia have been inconsistent. 7,15,[22][23][24][25][26] To our knowledge, no study before ours has examined the issue regarding G-CSF in patients with solid tumors beyond one to three cycles of chemotherapy. The comparable platelet transfusion requirements of our two groups 1) reflect the immediate thrombocytopenic potency of the chemotherapy, regardless of G-CSF usage, and 2) indicate a problem with delay in full recovery of platelet counts rather than with the depth of nadir counts.…”

Cost analysis of filgrastim for the prevention of neutropenia in pediatric T-cell leukemia and advanced lymphoblastic lymphoma: A case for prospective economic analysis in cooperative group trials

“…In contrast, one other report in the literature found a cost savings for G-CSF use in the pediatric setting. Riikonen et al demonstrated a $1,033 savings per chemotherapy cycle for 16 pediatric cancer patients (mainly hematologic malignancies) receiving G-CSF as treatment for febrile neutropenia [6,7]. Clearly the use of growth factors, though seeming to provide some clinical benefit, for pediatric leukemia requires further investigation and optimization.…”

“…However, this treatment can be highly toxic, causing severe and prolonged neutropenia and delays in therapy and/or repeated hospitalizations. Studies have been published investigating the use of colony-stimulating factors (CSFs) as prophylactic or adjunct therapy for chemotherapyinduced neutropenia in pediatric patients [5][6][7]. The aim of this treatment is to reduce the length of time and severity of neutropenia and the risk of infection.…”

“…This should subsequently reduce the total costs of care by minimizing hospitalization and the use of parenteral antibiotics. However, there is uncertainty whether use of CSFs will result in meaningful improvements in clinical outcomes and whether these benefits will be worth the additional costs associated with routine use of CSFs in the pediatric setting [5][6][7].…”

Prospective and randomized comparison of early versus delayed prophylactic administration of granulocyte colony-stimulating factor (filgrastim) in children with cancer

“…In our previous study we evaluated the use of G-CSF as an adjunct to courses of conventional chemotherapy in children with cancer [6]. We found that the use of G-CSF (+1 day postchemotherapy) facilitated myeloid recovery significantly and reduced the number of infectious complications and hospital days due to febrile neutropenia.…”