July 13, 2015
To help doctors provide their patients with the highest quality care, the American Society of Clinical Oncology (ASCO) recently updated a guideline developed in 2006 on when to use white blood cell growth factors to prevent infection. This guide for patients is based on ASCO’s most recent recommendations.
About white blood cell growth factors
White blood cell growth factors are proteins that help the body produce white blood cells. They are also called hematopoietic, meaning blood-forming, colony-stimulating factors (CSFs). White blood cells help fight infection and can be destroyed during some types of cancer treatment.
Having low numbers of white blood cells is called neutropenia. People with neutropenia are more likely to develop infections. Some people with neutropenia develop a fever, called febrile neutropenia, and some do not. Febrile neutropenia may be a sign of an infection. A person with febrile neutropenia may need antibiotics and to stay in the hospital until the infection is gone.
CSFs are supportive medications. This means that they do not treat the cancer, but prevent patients from developing side effects of cancer treatment, such as infections. CSFs are given as shots, usually 24 hours after a chemotherapy treatment, and include filgrastim (Neupogen, Zarxio), sargramostim (Leukine), and pegfilgrastim (Neulasta). These medications are made in the laboratory and are similar to those naturally produced by the body.
Benefits and risks of CSFs
Like other medications, CSFs have both risks and benefits. Receiving CSFs can lower your risk of needing to stay in the hospital because of febrile neutropenia. However, CSFs involve multiple shots to deliver the medication and can also cause low-grade fever, generally feeling unwell, and bone pain. Many patients may be concerned about bone pain from CSFs. However, it is a sign that the CSFs are working because the pain is caused by the bone marrow making more blood cells.
Your doctor can help determine your need for a CSF based on your risk of developing febrile neutropenia. This risk depends on the cancer diagnosis, the cancer treatment you are receiving, the treatment dose and schedule, and your medical history, age, and overall health.
Recommendations for using CSFs to prevent febrile neutropenia
The general recommendations for the use of CSFs include the following:
The first option is for your doctor to recommend an effective chemotherapy regimen that doesn’t require the use of CSFs, if possible.
CSFs may be recommended if your risk of developing febrile neutropenia is about 20% or greater. Your doctor will estimate your risk based on the type of cancer you have, your treatment plan, age, medical history, and other factors. Some of the factors your doctor will consider before recommending CSFs includes:
Whether you are receiving dose dense chemotherapy. Dose dense chemotherapy is given more often, such as every two weeks instead of every three weeks.
Whether you are older than 65, have lymphoma, and are receiving chemotherapy to cure the disease
Whether you have another health condition that increases your risk of developing complications from neutropenia
Sometimes, CSFs are not recommended. Please talk with your doctor for more information. Some of these situations include:
If you are receiving chemotherapy and radiation therapy at the same time
If you are receiving chemotherapy with a risk of febrile neutropenia that is less than 20%, which includes most chemotherapy regimens, and do not have health conditions that put you at high risk of febrile neutropenia.
What this means for patients
CSFs are supportive medications that can help you avoid staying in the hospital because of an infection. These medications are not necessary for everyone receiving cancer treatment, just for those patients who have a higher risk of developing febrile neutropenia. Most chemotherapy regimens are not linked with a high risk of developing febrile neutropenia. Your doctor can help you understand CSF treatment and how to manage the side effects of these medications if you need to take CSFs.
Questions to ask your doctor
Patients are encouraged to ask their doctors the following questions about CSFs:
Is there an effective chemotherapy regimen for my type of cancer that might not require the use of CSFs?
If I am prescribed a CSF, what are the risks of this treatment? What are the possible benefits?
What can be done to treat bone aches and joint pain?
How long does this pain last?
How can I tell if the bone pain is from CSF treatment and not from the spread of cancer?
What do I do if I have bone pain with a fever?
Read the entire clinical practice guideline at www.asco.org/guidelines/wbcgf.