New directions in the management of chemotherapy-induced neutropenia: Risk models, special populations, and quality of life

Abstract

New directions in managing chemotherapy-induced neutropenia include the development and validation of patient-based predictive risk models to guide the use of prophylactic colony-stimulating factors (CSFs) and an emerging recognition of the possible impact of chemotherapy-induced neutropenia on patient quality of life. Predictive risk models are being developed to identify patients who are at greater risk of neutropenic complications so that prophylactic CSF can be targeted to them in a timely and cost-effective manner. Current practice dictates the use of CSF prophylaxis primarily on the basis of the chemotherapy regimen; the risk-model approach is based on individual patient risk factors, which may be unconditional (before treatment) or conditional (after the first cycle). Within this new paradigm are patients with special circumstances, in whom prophylactic CSF treatment is currently recommended. Clinical evidence suggests that elderly patients are at particular risk for myelosuppression and should be considered for prophylactic CSF treatment starting with the first chemotherapy cycle. Analytical tools to measure the facets of quality of life related to neutropenia are being tested for validity and will be incorporated in future clinical trials. Thus, the future of neutropenia management promises to further refine the cost-effective use of CSF, while improving our understanding of the impact that chemotherapy-induced neutropenia has on quality of life.