Colony-stimulating factors for febrile neutropenia during cancer therapy

Abstract

A 55-year-old, previously healthy woman received a diagnosis of diffuse large-B-cell lymphoma after the evaluation of an enlarged left axillary lymph node obtained on biopsy. She had been asymptomatic except for the presence of enlarged axillary lymph nodes, which she had found while bathing. She was referred to an oncologist, who performed a staging evaluation. A complete blood count and test results for liver and renal function and serum lactate dehydrogenase were normal. Positron-emission tomography and computed tomography (PET–CT) identified enlarged lymph nodes with abnormal uptake in the left axilla, mediastinum, and retroperitoneum. Results on bone marrow biopsy were normal. The patient’s oncologist recommends treatment with six cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone with rituximab (CHOP-R) at 21-day intervals. Is the administration of prophylactic granulocyte colony-stimulating factor (G-CSF) with the first cycle of chemotherapy indicated?

Figure 1. Use of Hematopoietic Growth Factors in the Survival and Differentiation of Hematopoietic Cells

Blood-cell development progresses from a hematopoietic stem cell (HSC) through sequential stages of differentiation, ultimately giving rise to the individual mature cell types found in the circulation, including platelets, erythrocytes, monocytes, neutrophils, eosinophils, basophils, T cells, natural killer (NK) cells, and B cells. Cytokines and growth factors that support the survival, proliferation, or differentiation of each type of cell are shown. The highlighted sequence shows the differentiation pathway for granulocytes (neutrophils, eosinophils, and basophils). Granulocyte–macrophage colony-stimulating factor (GM-CSF) supports the differentiation of common myeloid progenitors (CMP) into common granulocyte–monocyte progenitors (GM). Granulocyte colony-stimulating factor (G-CSF) supports the differentiation of committed granulocyte progenitors (GP) into mature granulocytes. BCP denotes B-cell progenitor, CLP common lymphoid progenitor, EP erythrocyte progenitor, EPO erythropoietin, IL interleukin, M-CSF macrophage colony-stimulating factor, MEP megakaryocyte–erythrocyte progenitor, MkP megakaryocyte progenitor, MP monocyte progenitor, NKP natural-killer-cell progenitor, SCF stem-cell factor, TCP T-cell progenitor, TNK T-cell–natural-killer-cell progenitor, and TPO thrombopoietin.