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Myeloid Growth Factors

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Infections in Hematology

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Abstract

The cytotoxic therapy of malignant diseases can cause myelosuppression. Neutropenia, febrile neutropenia, and neutropenia-related infections are dose-limiting events during chemotherapy of malignant diseases. The risk of febrile neutropenia and infection is directly related to the degree and duration of neutropenia. Apart from more frequent days in hospital and higher mortality, febrile neutropenia and neutropenia-related infections often require dose-reduction of cytostatic drugs or longer intervals between treatment courses. The application of the intended dose on time may improve tumor response and overall survival; thus, a reduction of the intended dose intensity can impair the treatment results. G-CSF and GM-CSF stimulate the hematopoietic progenitor cells of granulopoiesis and enhance proliferation and differentiation thereby increasing the number of functional neutrophils.

Many clinical trials have established the clinical usefulness of prophylactic G-CSF or GM-CSF-therapy following chemotherapy to shorten neutropenia. It has convincingly been shown that the rate of febrile neutropenia, infections during neutropenia, and neutropenia-related mortality can be significantly reduced by the use of myeloid growth factors; the majority of trials have been performed with G-CSF.

The guidelines of ASCO, EORTC, and NCCN recommend using G-CSF as primary infection prophylaxis, if the likelihood of febrile neutropenia is at least 20 % following chemotherapy. Thus, treatment protocols have to be considered according the risk of causing febrile neutropenia. If the risk is between 10 and 20 %, G-CSF is not primarily necessary; however, additional treatment or patient-specific risk factors have to be considered and may indicate to use G-CSF. In order to assess the risk of febrile neutropenia and the treatment with G-CSF, the decision following an algorithm is proposed.

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Authors and Affiliations

  1. Department Internal Medicine, Hematology and Oncology, Westpfalz-Klinikum, Kaiserslautern, Germany

    Hartmut Link

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Correspondence to Hartmut Link .

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Editors and Affiliations

  1. Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany

    Georg Maschmeyer

  2. Department of Infectious Diseases, Infection Control and Employee Health, M.D. Anderson Cancer Center University of Texas, Houston, Texas, USA

    Kenneth V.I. Rolston

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© 2015 Springer-Verlag Berlin Heidelberg

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Link, H. (2015). Myeloid Growth Factors. In: Maschmeyer, G., Rolston, K. (eds) Infections in Hematology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-44000-1_18

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  • DOI: https://doi.org/10.1007/978-3-662-44000-1_18

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  • Online ISBN: 978-3-662-44000-1

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