G-CSF for prophylaxis of neutropenia and febrile neutropenia, anemia in cancer Guidelines on supportive treatment part 1

Infections in patients with neutropenia following chemotherapy are mostly manifested as fever (febrile neutropenia, FN). Some of the most important determinants of the risk of FN are the type of chemotherapy, the dose intensity and patient-specific factors. When the risk of FN is 20% or more granulopoiesis is prophylactically stimulated with granulocyte colony stimulating factor (G-CSF) after the treatment. Anemia should always be clarified and if necessary be treated according to the cause when symptomatic. If an absolute or functional iron deficiency is present, intravenous iron substitution is mostly necessary. Erythropoiesis-stimulating agents can be used after chemotherapy with hemoglobin (Hb) levels less than 10 g/dl (6.2 mmol/l). In cases of chronic anemia and Hb levels less than 7-8 g/dl (<4.3-5.0 mmol/l) the indications for transfusion of erythrocyte concentrates should be assessed primarily based on the individual clinical symptoms.

Automated summary

The risk of febrile neutropenia is influenced by chemotherapy type, dose intensity, and patient-specific factors. Granulopoiesis can be stimulated prophylactically with G-CSF when the risk is 20% or higher. Anemia should be treated according to the cause, and intravenous iron substitution may be necessary for iron deficiency. Erythropoiesis-stimulating agents can be used for chemotherapy-induced anemia with low hemoglobin levels.