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Shmuely H, Monely L, Shvidel L. All-Cause Mortality and Its Predictors in Haemato-Oncology Patients with Febrile Neutropenia. J Clin Med 2023; 12:5635. [PMID: 37685702 PMCID: PMC10489066 DOI: 10.3390/jcm12175635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Febrile neutropenia (FN) is one of the most important life-threatening complications in haemato-oncology. Our objective was to report all-cause mortality rates in patients ill with a hematological malignancy (HM) hospitalized with a first FN episode and to identify predictors for mortality. We conducted a historical retrospective cohort study of consecutive patients with an HM, >18 years of age, admitted between January 2012 and August 2018 for a first episode of FN. Data on all-cause mortality 12 months after admission for FN were obtained. The Kaplan-Meier curve was used to describe mortality during the follow-up period. Univariate and multivariable analyses identified predictors for 1,3 and 12-month mortality. One hundred and fifty-eight patients (mean age 69.5, 49.4% males) were included. Overall, 54 patients died (15.8%, 25.9%, and 34.1% died after 1, 3, and 12 months, respectively). Lower serum albumin, higher serum gamma-glutamyl transferase (GGT), lower estimated glomerular filtration rate (eGFR), older age, higher temperature, and lower absolute lymphocyte count at admission were independent predictors of all-cause mortality after 12 months. Further studies are needed to confirm our results and identify therapeutic strategies to improve survival.
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Affiliation(s)
- Haim Shmuely
- Department of Internal Medicine D, Kaplan Medical Center, Rehovot 7612001, Israel;
- Faculty of Medicine, Hebrew University, Jerusalem 9112001, Israel;
| | - Lea Monely
- Department of Internal Medicine D, Kaplan Medical Center, Rehovot 7612001, Israel;
- Faculty of Medicine, Hebrew University, Jerusalem 9112001, Israel;
| | - Lev Shvidel
- Faculty of Medicine, Hebrew University, Jerusalem 9112001, Israel;
- Institute of Hematology, Kaplan Medical Center, Rehovot 7612001, Israel
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Loss of microbiota-derived protective metabolites after neutropenic fever. Sci Rep 2022; 12:6244. [PMID: 35428797 PMCID: PMC9012881 DOI: 10.1038/s41598-022-10282-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/05/2022] [Indexed: 11/08/2022] Open
Abstract
Neutropenic fever (NF) is a common complication of chemotherapy in patients with cancer which often prolongs hospitalization and worsens the quality of life. Although an empiric antimicrobial approach is used to prevent and treat NF, a clear etiology cannot be found in most cases. Emerging data suggest an altered microbiota-host crosstalk leading to NF. We profiled the serum metabolome and gut microbiome in longitudinal samples before and after NF in patients with acute myeloid leukemia, a prototype setting with a high incidence of NF. We identified a circulating metabolomic shift after NF, with a minimal signature containing 18 metabolites, 13 of which were associated with the gut microbiota. Among these metabolites were markers of intestinal epithelial health and bacterial metabolites of dietary tryptophan with known anti-inflammatory and gut-protective effects. The level of these metabolites decreased after NF, in parallel with biologically consistent changes in the abundance of mucolytic and butyrogenic bacteria with known effects on the intestinal epithelium. Together, our findings indicate a metabolomic shift with NF which is primarily characterized by a loss of microbiota-derived protective metabolites rather than an increase in detrimental metabolites. This analysis suggests that the current antimicrobial approach to NF may need a revision to protect the commensal microbiota.
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Febrile Neutropenia Duration Is Associated with the Severity of Gut Microbiota Dysbiosis in Pediatric Allogeneic Hematopoietic Stem Cell Transplantation Recipients. Cancers (Basel) 2022; 14:cancers14081932. [PMID: 35454840 PMCID: PMC9026899 DOI: 10.3390/cancers14081932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 01/04/2023] Open
Abstract
Simple Summary Febrile neutropenia is a common complication in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation. Its genesis is often attributed to infections; however, a specific cause frequently cannot be defined. We hypothesize that the composition of the intestinal flora may contribute to the genesis of the neutropenic fever. We analyzed the microbial composition of stool samples from pediatric patients from three European centers and assessed the relationship with the duration of the fever during neutropenia. We found that a more stable composition of the microbiota during the transplantation course is associated with a shorter duration of fever. Moreover, patients with a higher duration of fever presented higher levels of Collinsella, Megasphaera, Prevotella, Roseburia, Eggerthella and Akkermansia in the stool. Abstract Febrile neutropenia (FN) is a common complication in pediatric patients receiving allogeneic hematopoietic stem cell transplantation (HSCT). Frequently, a precise cause cannot be identified, and many factors can contribute to its genesis. Gut microbiota (GM) has been recently linked to many transplant-related complications, and may also play a role in the pathogenesis of FN. Here, we conducted a longitudinal study in pediatric patients receiving HSCT from three centers in Europe profiling their GM during the transplant course, particularly at FN onset. We found that a more stable GM configuration over time is associated with a shorter duration of fever. Moreover, patients with longer lasting fever exhibited higher pre-HSCT levels of Collinsella, Megasphaera, Prevotella and Roseburia and increased proportions of Eggerthella and Akkermansia at the engraftment. These results suggest a possible association of the GM with the genesis and course of FN. Data seem consistent with previous reports on the relationship of a so-called “healthy” GM and the reduction of transplant complications. To our knowledge, this is the first report in the pediatric HSCT setting. Future studies are warranted to define the underling biological mechanisms and possible clinical implications.
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Seltzer JA, Frankfurt O, Kyriacou DN. Association of an emergency department febrile neutropenia intervention protocol with time to initial antibiotic treatment. Acad Emerg Med 2022; 29:73-82. [PMID: 34245642 DOI: 10.1111/acem.14335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Earlier initial antibiotic treatment for febrile neutropenia is associated with improved clinical outcomes. This study was conducted to evaluate the association of an emergency department (ED) intervention protocol with time to initial antibiotic treatment for febrile neutropenia patients. METHODS We conducted a cohort study of adult ED febrile neutropenia patients before and after implementation of an intervention protocol. Analyses included comparison of means and medians, Kaplan-Meier estimates, multivariable regression analyses, interrupted time-series analyses, and causal mediation analyses. The intervention protocol included specific triage and process-of-care actions to reduce the primary outcome of time to initial antibiotic treatment. RESULTS There were 69 patients in the 12-month preintervention period and 52 patients in the 8-month postintervention period. The mean (±SD) times to initial antibiotics were 197.6 (±85.4) min for the preintervention group and 97.7 (±51.0) min for the postintervention group (difference of 99.9 min with 95% confidence interval [CI] = 73.5 to 126.4, p < 0.001). The patients' probability for receiving initial antibiotics within 90 min was severalfold greater (adjusted risk ratio = 10.31, 95% CI = 4.99 to 21.30, p < 0.001) for the postintervention group versus preintervention group. ED length of stay, hospital length of stay, 30-day readmissions, and 30-day all-cause mortality were not different between the study groups. The association of the intervention protocol with time to initial antibiotics appeared to be mediated through times to treatment room placement, report of absolute neutrophil count, and initial antibiotic order. CONCLUSIONS The intervention protocol was associated with a significant reduction in time to initial antibiotics for ED patients with febrile neutropenia. This association appears to be facilitated through specific intermediate process-of-care variables. A larger multicenter study is needed to assess the potential effects of an ED febrile neutropenia protocol on patient-centered clinical outcomes and resource utilization.
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Affiliation(s)
- Justin A. Seltzer
- Department of Emergency Medicine Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Olga Frankfurt
- Division of Hematology and Oncology Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Demetrios N. Kyriacou
- Department of Emergency Medicine Northwestern University Feinberg School of Medicine Chicago Illinois USA
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago Illinois USA
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5
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Lapidari P, Vaz-Luis I, Di Meglio A. Side effects of using granulocyte-colony stimulating factors as prophylaxis of febrile neutropenia in cancer patients: A systematic review. Crit Rev Oncol Hematol 2021; 157:103193. [DOI: 10.1016/j.critrevonc.2020.103193] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 12/29/2022] Open
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Catala G, Mebis J, Jerusalem G, Verhoeven D, Awada A, Bols A, Somers L, Van Den Broeck A, Duhoux FP, Machiels JP. Neutropenia management in patients receiving myelosuppressive polychemotherapy for early breast cancer in Belgium: BRONS study results. Acta Clin Belg 2020; 75:128-135. [PMID: 30609907 DOI: 10.1080/17843286.2018.1563735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Chemotherapy plays an important role in the treatment of early breast cancer (EBC). Granulocyte-colony stimulating factors (G-CSF) can reduce the risk of febrile neutropenia as primary prophylaxis (PP) or secondary prophylaxis (SP). The BRONS study investigated the incidence of serious neutropenic events (SNE) and G-CSF use in a Belgian population of EBC patients treated with myelosuppressive polychemotherapy.Methods: Conducted in 2011, this study was a prospective, multicentre, observational trial involving 260 patients. The primary endpoint was the incidence of SNE defined as either febrile neutropenia (FN) or prolonged severe neutropenia (PSN; neutrophil count ≤0.5 × 10⁹ for at least five days). Secondary endpoints included a description of the chemotherapeutic regimens prescribed and G-CSF use.Results: Nine percent of patients were treated with a dose-dense regimen (DD) and 91% received classical chemotherapy (CC). PP with G-CSF (PPG) was given to 20% of patients (100% in DD and 11% in CC). Eighteen percent of patients presented a SNE (4% in DD and 20% in CC) of which 15% were FN and 3% PSN. SNE occurrence was 8% in the PPG subgroup and 21% in the no-PPG subgroup. In the DD subgroup, all patients received PPG and no FN was reported. Twenty six adverse events related to G-CSF were reported in 8.2% of patients and two of these were classified as severe.Conclusion: This observational study highlights the high incidence of SNE with CC regimens in patients who do not receive PPG. It also confirms the safe profile of DD regimens with G-CSF support.
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Affiliation(s)
- Gaetan Catala
- Department of Medical Oncology, Cliniques universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale (Pole MIRO), Institut Roi Albert II, Université catholique de Louvain, Brussels, Belgium
| | - Jeroen Mebis
- Department of Medical Oncology, Jesse Ziekenhuis, Hasselt, Belgium
| | - Guy Jerusalem
- Department of Medical Oncology, CHU Sart Tilman, Liège University, Liège, Belgium
| | | | - Ahmad Awada
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Alain Bols
- Department of Medical Oncology, AZ Sint Jan, Brugge, Belgium
| | | | | | - Francois P Duhoux
- Department of Medical Oncology, Cliniques universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale (Pole MIRO), Institut Roi Albert II, Université catholique de Louvain, Brussels, Belgium
| | - Jean-Pascal Machiels
- Department of Medical Oncology, Cliniques universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale (Pole MIRO), Institut Roi Albert II, Université catholique de Louvain, Brussels, Belgium
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7
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Van Ryckeghem F, Haverbeke C, Wynendaele W, Jerusalem G, Somers L, Van den Broeck A, Vingerhoedt S, Van Belle S. Real-world use of granulocyte colony-stimulating factor in ambulatory breast cancer patients: a cross-sectional study. Support Care Cancer 2018; 27:1099-1108. [PMID: 30099601 DOI: 10.1007/s00520-018-4399-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/03/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To prevent febrile neutropenia (FN), European Organisation for Research and Treatment of Cancer (EORTC) guidelines recommend primary prophylaxis with granulocyte colony-stimulating factors (PPG) for patients at high risk (≥ 20%) of FN. In Belgium, the use of PPG is restricted by specific reimbursement criteria. The impact of these criteria on PPG use and adherence to guidelines is unknown. METHODS This multicentre, cross-sectional, observational study aimed to describe PPG use by FN risk category in breast cancer patients who were scheduled to receive myelosuppressive chemotherapy in outpatient clinics in Belgium during a 2-week period between 13 October and 12 December 2014. RESULTS In total, 490 patients were enrolled. Median age was 57.0 years. Based on their chemotherapy regimen, 53.9, 5.1 and 41.0% of patients were at a low, intermediate and high risk of FN, respectively. Overall, 39.8% of patients received PPG (17.0, 12.0 and 73.1% of those receiving low-, intermediate- and high-risk regimens, respectively). In the high-risk category, PPG was used in 89.9% of dose-dense and in 25.0% of classical chemotherapy regimens. PPG use was adherent to EORTC guidelines in 75.3% of patients (30.6% appropriate use, 44.7% appropriate non-use). EORTC guidelines would recommend PPG use in 46.1% of this study population (n = 226), and its use was reimbursable in Belgium in 76.1% of these patients (n = 172), but only 66.4% of them received PPG (n = 150). CONCLUSIONS Both Belgian reimbursement criteria and physician decision-making led to a proportion of patients for whom PPG treatment was recommended but finally not receiving it.
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Affiliation(s)
| | - Chloë Haverbeke
- Gent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Wim Wynendaele
- Department of Medical Oncology, Imelda Hospital, Bonheiden, Belgium
| | - Guy Jerusalem
- CHU Sart Tilman Liège and University of Liège, Liège, Belgium
| | | | | | | | - Simon Van Belle
- Gent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
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Tilleul P, Jacot W, Emery C, Lafuma A, Gourmelen J. Management and cost analysis of cancer patients treated with G-CSF: a cohort study based on the French national healthcare insurance database. J Med Econ 2017; 20:1261-1267. [PMID: 28795868 DOI: 10.1080/13696998.2017.1366324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To describe the management and costs associated with G-CSF therapy in cancer patients in France. METHODS This study analyzed a representative random population sample from the French national healthcare insurance database, focusing on 1,612 patients with hematological or solid malignancies who were reimbursed in 2013 or 2014 for at least one G-CSF treatment dispensed in a retail pharmacy. Patient characteristics and treatment costs were analyzed according to the type of cancer. Then the costs and characteristics of patients associated with the use of different G-CSF products were analyzed in the sub-set of breast cancer patients. RESULTS The most frequent malignancies in the database population were breast cancer (23.3%), hematological malignancies (22.2%), and lung cancer (12.4%). The reimbursed G-CSF was pegfilgrastim in 34.1% of cases, lenograstim in 26.7%, and filgrastim in 17.9%. More than one G-CSF product was reimbursed to 21.3% of patients. The total annual reimbursed health expenses per patient, according to the type of G-CSF, were €27,001, €24,511, and €20,802 for patients treated with filgrastim, lenograstim, and pegfilgrastim, respectively. Ambulatory care accounted for, respectively, 35%, 38%, and 41% of those costs. In patients with breast cancer, ambulatory care cost was €7,915 with filgrastim, €7,750 with lenograstim, and €6,989 with pegfilgrastim, and the respective cost of G-CSF was €1,733, €1,559, and €3,668. CONCLUSION All available G-CSF products have been shown to be effective in cancer patients, and both daily G-CSFs and pegylated G-CSF are recommended in international guidelines. Nevertheless, this analysis of G-CSF reimbursement indicates that the choice of product can markedly affect the total cost of ambulatory care.
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Affiliation(s)
- Patrick Tilleul
- a Pharmacy Department , Pitié Salpetrière APHP/Paris Sorbonne University of Pharmacy , Paris , France
| | - William Jacot
- b Department of Medical Oncology , Institut Régional Du Cancer Montpellier ICM , Montpellier , France
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9
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Brown J, Grudzen C, Kyriacou DN, Obermeyer Z, Quest T, Rivera D, Stone S, Wright J, Shelburne N. The Emergency Care of Patients With Cancer: Setting the Research Agenda. Ann Emerg Med 2016; 68:706-711. [PMID: 26921969 PMCID: PMC5001927 DOI: 10.1016/j.annemergmed.2016.01.021] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/11/2016] [Accepted: 01/19/2016] [Indexed: 12/21/2022]
Abstract
To identify research priorities and appropriate resources and to establish the infrastructure required to address the emergency care of patients with cancer, the National Institutes of Health's National Cancer Institute and the Office of Emergency Care Research sponsored a one-day workshop, "Cancer and Emergency Medicine: Setting the Research Agenda," in March 2015 in Bethesda, MD. Participants included leading researchers and clinicians in the fields of oncology, emergency medicine, and palliative care, and representatives from the National Institutes of Health. Attendees were charged with identifying research opportunities and priorities to advance the understanding of the emergency care of cancer patients. Recommendations were made in 4 areas: the collection of epidemiologic data, care of the patient with febrile neutropenia, acute events such as dyspnea, and palliative care in the emergency department setting.
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Affiliation(s)
- Jeremy Brown
- Office of Emergency Care Research, National Institute of General Medical Sciences, New York, NY.
| | - Corita Grudzen
- Department of Emergency Medicine, New York University School of Medicine, New York, NY
| | - Demetrios N Kyriacou
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ziad Obermeyer
- Department of Emergency Medicine and Health Care Policy, Harvard Medical School, Boston, MA
| | - Tammie Quest
- Department of Emergency Medicine and Division of Geriatrics and Gerontology, Emory University, Atlanta, GA
| | - Donna Rivera
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Susan Stone
- Palliative Care Services, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jason Wright
- Columbia University College of Physicians and Surgeons, New York, NY
| | - Nonniekaye Shelburne
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
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Fruehauf S, Otremba B, Stötzer O, Rudolph C. Compatibility of Biosimilar Filgrastim with Cytotoxic Chemotherapy during the Treatment of Malignant Diseases (VENICE): A Prospective, Multicenter, Non-Interventional, Longitudinal Study. Adv Ther 2016; 33:1983-2000. [PMID: 27743353 PMCID: PMC5083766 DOI: 10.1007/s12325-016-0419-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Indexed: 11/17/2022]
Abstract
Introduction Febrile neutropenia (FN) is a serious and frequent complication of cytotoxic chemotherapy. Biosimilar filgrastim (Nivestim™, Hospira Inc, A Pfizer Company, Lake Forest, IL, USA) is a granulocyte-colony stimulating factor licensed for the treatment of neutropenia and FN induced by myelosuppressive chemotherapy. The primary goal of this VENICE study (ClinicalTrials.gov identifier, NCT01627990) was to observe the tolerability, safety and efficacy of biosimilar filgrastim in patients receiving cancer chemotherapy. Methods This was a prospective, multicenter, non-interventional, longitudinal study. Consenting adult patients with solid tumors or hematologic malignancies for whom cytotoxic chemotherapy and treatment with biosimilar filgrastim was planned were enrolled. Results Among the enrolled patients (N = 386), 81% were female, with a median age (range) of 61 (22–92) years, with 39% >65 years old. Most patients (n = 338; 88%) had solid tumors and the remainder (n = 49; 13%) had hematological malignancies. The majority of the patients (64%) received biosimilar filgrastim as primary prophylaxis and 36% as secondary prophylaxis. At the follow-up visits, for the majority of patients (95.6%) there had been no change in chemotherapy dose due to FN. For two patients (0.5%) the chemotherapy was discontinued due to FN and for four patients (1.0%) the chemotherapy dose was reduced due to FN. For the majority of patients (96.9%) the chemotherapy cycle following the first biosimilar filgrastim treatment was not delayed due to FN. For 3 patients (0.8%), the chemotherapy was delayed following the first biosimilar filgrastim treatment. Less than one-third (29.8%) of the patients experienced ≥1 adverse event that was at least potentially related to biosimilar filgrastim treatment. Conclusions Biosimilar filgrastim was effective and well-tolerated in both the primary and secondary prophylactic setting in patients undergoing chemotherapy for solid tumors and hematological malignancies. Trial Registration ClinicalTrials.gov identifier, NCT01627990. Funding Hospira Inc, A Pfizer Company, Lake Forest, IL, USA.
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Nahon S, Rastkhah M, Ben Abdelghani M, Soumoudronga RF, Gasnereau I, Labourey JL. Zarzio®, biosimilar of filgrastim, in prophylaxis of chemotherapy-induced neutropenia in routine practice: a French prospective multicentric study. Support Care Cancer 2016; 24:1991-1998. [PMID: 26507190 PMCID: PMC4805722 DOI: 10.1007/s00520-015-2986-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/09/2015] [Indexed: 10/25/2022]
Abstract
PURPOSE Chemotherapy-induced neutropenia is a serious and potentially life-threatening consequence of cancer treatment. Prophylactic treatment with granulocyte-colony stimulating factor (G-CSF) decreases the incidence of febrile neutropenia, the rate of hospitalization, and the use of antibiotics in patients at risk. The aim of this study was to assess efficacy, safety, and use of Zarzio(®)-biosimilar of Neupogen(®) (G-CSF; filgrastim)-in prophylaxis of chemotherapy-induced neutropenia in current practice in cancer patients. METHODS We conducted an observational, prospective, longitudinal, and multicentric study in France. The incidence of neutropenia was evaluated at each cycle of chemotherapy. RESULTS One hundred eighty-four patients (women, 64.7 %; mean age, 61.7 years) with solid tumor (89.7 %; breast cancer, 50.5 %) or non-Hodgkin lymphoma (10.3 %) were included. The risk of febrile neutropenia based on chemotherapy regimen was >20 % for 32.1 % of patients. No case of febrile neutropenia was reported. Neutropenia was the cause of hospitalization and/or antibiotic therapy in 10 patients. The most frequent adverse events related to Zarzio(®) were pain, in particular bone pain. No serious adverse event related to Zarzio(®) was reported. CONCLUSION The results obtained in real-life conditions confirm that Zarzio(®) is efficient and well tolerated in cancer patients.
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Affiliation(s)
- Sophie Nahon
- Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | | | | | | | - Isabelle Gasnereau
- Sandoz Biopharmaceuticals, 49, Avenue Georges Pompidou, 92593, Levallois-Perret, Cedex, France.
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Cost-effectiveness of prophylactic granulocyte colony-stimulating factor for febrile neutropenia in breast cancer patients receiving FEC-D. Breast Cancer Res Treat 2015; 150:169-80. [DOI: 10.1007/s10549-015-3309-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 02/09/2015] [Indexed: 10/24/2022]
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13
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Mak WC, Yin Ching SS. Effect of an education program on knowledge, self-care behavior and handwashing competence on prevention of febrile neutropenia among breast cancer patients receiving Doxorubicin and Cyclophosphamide in Chemotherapy Day Centre. Asia Pac J Oncol Nurs 2015; 2:276-288. [PMID: 27981125 PMCID: PMC5123502 DOI: 10.4103/2347-5625.167232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To evaluate the efficacy of an education program on the prevention of febrile neutropenia (FN) among breast cancer patients receiving AC regimen. Methods: Randomized controlled trial with the repeated-measures design was conducted in a Chemotherapy Day Centre of an acute hospital in Hong Kong. Twenty-five subjects in the intervention group received an individual education session followed by three follow-up sessions and routine care. Twenty-four subjects in the control group received routine care. Primary outcomes included the incidence of admission due to FN, the self-care behavior adherence, the knowledge level on prevention of FN and the self-efficacy in self-management, handwashing competence were assessed by self-designed questionnaires, Chinese version of patient activation measure, and handwashing competence checklist. Results: No statistically significant difference between the intervention group and the control group on the incidence of admission due to FN, the self-efficacy in self-management, and the knowledge on prevention of FN. The self-care behavior adherence was significant at cycle 4 of AC regimen in favor of the intervention group (P = 0.036). Handwashing competence improved more significantly among subjects in the intervention group than the control group (P = 0.009). Conclusions: The education program on the prevention of FN had significantly favorable effects on self-care behavior adherence and handwashing competence across time. However, the intervention did not lead to statistically significant improvement on the incidence of admission due to FN, the self-efficacy in self-management and the knowledge level on prevention of FN.
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Affiliation(s)
- Wai Chi Mak
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, SAR, China
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14
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Gilbar P, McPherson I, Sorour N, Sanmugarajah J. High incidence of febrile neutropenia following adjuvant breast chemotherapy with docetaxel, carboplatin and trastuzumab. BREAST CANCER MANAGEMENT 2014. [DOI: 10.2217/bmt.14.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
SUMMARY Aim: To determine the incidence of febrile neutropenia (FN) following adjuvant chemotherapy with docetaxel, carboplatin and trastuzumab (TCH) for early-stage breast cancer and the grade of neutropenia after cycle one. Methods: A retrospective multicenter audit of patients with early-stage breast cancer treated with TCH, was conducted at four Australian hospitals between October 2009 and September 2013. Results: Of 79 patients analyzed, data from 78 women were evaluated for FN incidence and data from 64 women were evaluated for grade of neutropenia. After cycle one of TCH, 26 patients developed FN (33.3%). Following all cycles, 32 patients developed FN (41.0%). There was no statistical difference in the incidence of FN between hospitals or between age groups (above or below 65 years). After cycle one, ten patients developed grade 3 neutropenia (15.6%) and 37 patients developed grade 4 neutropenia (57.8%). Conclusion: This study demonstrates a high incidence of FN post-TCH chemotherapy thus supporting the use of granulocyte colony-stimulating factor as primary prophylaxis.
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Affiliation(s)
- Peter Gilbar
- Cancer & Palliative Care Services, Toowoomba Hospital, Toowoomba, QLD 4350, Australia
- School of Medicine, University of Queensland (Rural Clinical Division), Toowoomba, QLD 4350, Australia
| | - Ian McPherson
- Cancer & Palliative Care Services, Toowoomba Hospital, Toowoomba, QLD 4350, Australia
| | - Natacha Sorour
- Cancer & Palliative Care Services, Toowoomba Hospital, Toowoomba, QLD 4350, Australia
| | - Jasotha Sanmugarajah
- Department of Medical Oncology & School of Medicine, Griffith University, Gold Coast University Hospital, Southport, QLD 4215, Australia
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Agur Z, Elishmereni M, Kheifetz Y. Personalizing oncology treatments by predicting drug efficacy, side-effects, and improved therapy: mathematics, statistics, and their integration. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2014; 6:239-53. [DOI: 10.1002/wsbm.1263] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 12/23/2013] [Accepted: 01/03/2014] [Indexed: 01/21/2023]
Affiliation(s)
- Zvia Agur
- Institute for Medical BioMathematics; Hate'ena Bene Ataroth Israel
- Optimata Ltd.; Zichron Ya'akov; Tel Aviv Israel
| | - Moran Elishmereni
- Institute for Medical BioMathematics; Hate'ena Bene Ataroth Israel
- Optimata Ltd.; Zichron Ya'akov; Tel Aviv Israel
| | - Yuri Kheifetz
- Institute for Medical BioMathematics; Hate'ena Bene Ataroth Israel
- Optimata Ltd.; Zichron Ya'akov; Tel Aviv Israel
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Mullard AP, Misra V, Sumra P, Ali Z, O’Reilly SM, Malik Z. Reducing febrile neutropenia rates in early breast cancer. Experience of two UK cancer centres. Support Care Cancer 2014; 22:2033-7. [DOI: 10.1007/s00520-014-2141-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 01/22/2014] [Indexed: 11/29/2022]
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Abou Saleh M, Mafiana RN, Al Za'abi M, Vaishnav R, Al Kindi S, Al-Zakwani I. Epidemiology of chemotherapy-induced neutropenia at a tertiary university hospital in Oman. Int J Clin Pharm 2013; 35:1036-9. [PMID: 24101032 DOI: 10.1007/s11096-013-9859-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 09/23/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about the incidence and burden of chemotherapy-induced neutropenia (CIN) in Oman or the Arabian Gulf. OBJECTIVES To determine the epidemiology of CIN at Sultan Qaboos University Hospital in Oman. METHODS A retrospective observational study of all eligible CIN episodes in adult (>18 years) patients with solid tumors and hematological malignancies at Sultan Qaboos University Hospital (SQUH) from January to December 2010. Analyses were performed using univariate statistics. RESULTS A total of 1,357 episodes in 159 patients with a mean age of 50 ± 15 years (19-91) were evaluated. Fifty-four percent (n = 86) of the patients were female. A total of 46 % (73/159) of the patients developed CIN accounting for 15 % (210/1,357) of all episodes. Twelve percent (25/210) of these CIN episodes were associated with fever in 26 % (19/73) patients. There was significant association between CIN and chemotherapy regimen (P < 0.001), younger age (P < 0.001), low hemoglobin (Hb) levels (P < 0.001) and advanced cancer stage (P = 0.006). CONCLUSIONS This study suggests a high incidence of CIN in SQUH patients which resulted in chemotherapy delays, longer hospital stays, and inpatient mortality. CIN was significantly correlated with chemotherapy regimen, younger age, low Hb levels and cancer stage.
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Affiliation(s)
- Maram Abou Saleh
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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Vainas O, Ariad S, Amir O, Mermershtain W, Vainstein V, Kleiman M, Inbar O, Ben-Av R, Mukherjee A, Chan S, Agur Z. Personalising docetaxel and G-CSF schedules in cancer patients by a clinically validated computational model. Br J Cancer 2012; 107:814-22. [PMID: 22814580 PMCID: PMC3425973 DOI: 10.1038/bjc.2012.316] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: This study was aimed to develop a new method for personalising chemotherapeutic and granulocyte colony-stimulating factor (G-CSF) combined schedules, and use it for suggesting efficacious chemotherapy with reduced neutropenia. Methods: Clinical data from 38 docetaxel (Doc)-treated metastatic breast cancer patients were employed for validating a new pharmacokinetic/pharmacodynamics model for Doc, combined with a mathematical model for granulopoiesis. An optimisation procedure was constructed and used for selecting improved treatment schedules. Results: The combined model accurately predicted observed nadir timing (r=0.99), grade 3 or 4 neutropenia (86% success) and neutrophil counts over time in individual patients (r=0.63), and showed robustness to CYP3A-induced variability in Doc clearance. For average patients, the predicted optimal support for the standard chemotherapy regimen, Doc 100 μg m−2 tri-weekly, is G-CSF, 300 μg, Q1D × 3, starting day 7 post-Doc. This regimen largely moderates chemotherapy-induced neutrophil nadir and neutropenia duration. The more intensive Doc dose, 150 mg m−2, is optimally supported by the slightly less cost-effective G-CSF 300 μg, Q1D × 4, 5 days post-Doc. The latter regimen is optimal for borderline patients (2000 neutrophils per μl) under Doc, 100–150 mg m−2 tri-weekly. Conclusions: The new computational method can serve for tailoring efficacious cytotoxic and supportive treatments, minimising side effects to individual patients. Prospective clinical validation is warranted.
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Affiliation(s)
- O Vainas
- Optimata Ltd, 7 Abba Hillel Street, Ramat-Gan 52522, Israel
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Griffiths P, Richardson A, Blackwell R. Outcomes sensitive to nursing service quality in ambulatory cancer chemotherapy: Systematic scoping review. Eur J Oncol Nurs 2012; 16:238-46. [DOI: 10.1016/j.ejon.2011.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/31/2011] [Accepted: 06/12/2011] [Indexed: 11/29/2022]
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21
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Juutilainen A, Hämäläinen S, Pulkki K, Kuittinen T, Nousiainen T, Jantunen E, Koivula I. Biomarkers for bacteremia and severe sepsis in hematological patients with neutropenic fever: multivariate logistic regression analysis and factor analysis. Leuk Lymphoma 2011; 52:2349-55. [PMID: 21756036 DOI: 10.3109/10428194.2011.597904] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We compared biomarkers and their changes as predictors for bacteremia and severe sepsis during neutropenic fever after intensive chemotherapy in hematological patients. Serum C-reactive protein (CRP), semi-quantative procalcitonin, aminoterminal pro-brain natriuretic peptide (NT-proBNP), cortisol, lactate, plasma antithrombin and fibrinogen were measured daily from day 0 to day 3/day 4 in 89 neutropenic fever episodes of 65 hematological patients. The best predictors for bacteremia and gram-negative bacteremia were procalcitonin and its change, with odds ratios (ORs) and 95% confidence intervals of 2.63 (1.56-4.44) and 3.20 (1.77-5.80) for bacteremia and 4.14 (2.00-8.58) and 5.04 (2.18-11.63) for gram-negative bacteremia, respectively. For severe sepsis, the best predictors were CRP and fibrinogen, with ORs of 1.94 (1.07-3.52) and 1.92 (1.05-3.54). Factor analysis provided two predictive factors: procalcitonin-NT-proBNP-antithrombin factor predicted gram-negative bacteremia and CRP-fibrinogen predicted severe sepsis. Applying a combination of markers reflecting different aspects of infection might improve the recognition of risk for complications in patients with neutropenic fever.
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Affiliation(s)
- Auni Juutilainen
- Institute of Clinical Medicine/Internal Medicine, University of Eastern Finland, Kuopio, Finland.
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22
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Aapro MS, Bohlius J, Cameron DA, Dal Lago L, Donnelly JP, Kearney N, Lyman GH, Pettengell R, Tjan-Heijnen VC, Walewski J, Weber DC, Zielinski C. 2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours. Eur J Cancer 2010; 47:8-32. [PMID: 21095116 DOI: 10.1016/j.ejca.2010.10.013] [Citation(s) in RCA: 735] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 10/18/2010] [Indexed: 10/18/2022]
Abstract
Chemotherapy-induced neutropenia is a major risk factor for infection-related morbidity and mortality and also a significant dose-limiting toxicity in cancer treatment. Patients developing severe (grade 3/4) or febrile neutropenia (FN) during chemotherapy frequently receive dose reductions and/or delays to their chemotherapy. This may impact the success of treatment, particularly when treatment intent is either curative or to prolong survival. In Europe, prophylactic treatment with granulocyte-colony stimulating factors (G-CSFs), such as filgrastim (including approved biosimilars), lenograstim or pegfilgrastim is available to reduce the risk of chemotherapy-induced neutropenia. However, the use of G-CSF prophylactic treatment varies widely in clinical practice, both in the timing of therapy and in the patients to whom it is offered. The need for generally applicable, European-focused guidelines led to the formation of a European Guidelines Working Party by the European Organisation for Research and Treatment of Cancer (EORTC) and the publication in 2006 of guidelines for the use of G-CSF in adult cancer patients at risk of chemotherapy-induced FN. A new systematic literature review has been undertaken to ensure that recommendations are current and provide guidance on clinical practice in Europe. We recommend that patient-related adverse risk factors, such as elderly age (≥65 years) and neutrophil count be evaluated in the overall assessment of FN risk before administering each cycle of chemotherapy. It is important that after a previous episode of FN, patients receive prophylactic administration of G-CSF in subsequent cycles. We provide an expanded list of common chemotherapy regimens considered to have a high (≥20%) or intermediate (10-20%) risk of FN. Prophylactic G-CSF continues to be recommended in patients receiving a chemotherapy regimen with high risk of FN. When using a chemotherapy regimen associated with FN in 10-20% of patients, particular attention should be given to patient-related risk factors that may increase the overall risk of FN. In situations where dose-dense or dose-intense chemotherapy strategies have survival benefits, prophylactic G-CSF support is recommended. Similarly, if reductions in chemotherapy dose intensity or density are known to be associated with a poor prognosis, primary G-CSF prophylaxis may be used to maintain chemotherapy. Clinical evidence shows that filgrastim, lenograstim and pegfilgrastim have clinical efficacy and we recommend the use of any of these agents to prevent FN and FN-related complications where indicated. Filgrastim biosimilars are also approved for use in Europe. While other forms of G-CSF, including biosimilars, are administered by a course of daily injections, pegfilgrastim allows once-per-cycle administration. Choice of formulation remains a matter for individual clinical judgement. Evidence from multiple low level studies derived from audit data and clinical practice suggests that some patients receive suboptimal daily G-CSFs; the use of pegfilgrastim may avoid this problem.
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Affiliation(s)
- M S Aapro
- Multidisciplinary Oncology Institute, Clinique de Genolier, 1, route du Muids, 1272 Genolier, Switzerland.
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Abstract
The development of febrile neutropenia during a course of chemotherapy is not only a life-threatening complication, it can also lead to a decision to reduce chemotherapy intensity in subsequent treatment cycles, thus putting patient outcomes at risk. Although there are strategies available for the primary prevention of febrile neutropenia, these are not widely used in the UK management of breast cancer. It is, therefore, paramount to have a well thought out and rigorously implemented care protocol for febrile neutropenia, involving patients, family/carers and health-care professionals in both primary and secondary care, to ensure early detection and effective management.
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Affiliation(s)
- D Cameron
- NCRN Coordinating Centre, University of Leeds, MacMillan Wing, Fairbairn House, 71-75 Clarendon Road, Leeds LS2 9PH, UK.
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Abstract
Febrile neutropenia (FN) causes significant morbidity and mortality in patients receiving cytotoxic chemotherapy and can lead to reduced chemotherapy dose intensity and increased overall treatment costs. Antibiotic prophylaxis reduces the incidence of FN. Recent research and meta-analyses confirm that prophylactic fluoroquinolones decrease FN and infection-related mortality in patients with acute leukaemia and those receiving high-dose chemotherapy. Fluoroquinolone prophylaxis also lowers the incidence of FN and all-cause mortality following the first cycle of myelosuppressive chemotherapy for solid tumours. Levofloxacin has been the agent studied most thoroughly in this context. Although there is no convincing evidence that colonisation of individuals with resistant organisms due to antibiotic prophylaxis increases FN or mortality, such concerns must be taken seriously and the use of prophylaxis should be limited responsibly for patients with the greatest chance of benefit. Fluoroquinolone prophylaxis is well tolerated and cost-effective and should be offered to patients receiving chemotherapy for haematological malignancies and high-dose chemotherapy for solid tumours in which prolonged (>7 days) neutropenia is expected. It should also be considered for those receiving chemotherapy for solid tumours and lymphomas during the first cycle of chemotherapy when grade 4 neutropenia is anticipated.
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Affiliation(s)
- M Cullen
- University Hospital Birmingham Cancer Centre, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK.
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