Patients Aged ≥ 70 Are at High Risk for Neutropenic Infection and Should Receive Hemopoietic Growth Factors When Treated With Moderately Toxic Chemotherapy

Article Tools SPECIAL DEPARTMENTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2001.19.5.1583 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 11230505 Patients Aged ≥ 70 Are at High Risk for Neutropenic Infection and Should Receive Hemopoietic Growth Factors When Treated With Moderately Toxic Chemotherapy Lodovico BalduccixLodovico BalducciSearch for articles by this author , Gary H. LymanxGary H. LymanSearch for articles by this author Howard OzerxHoward OzerSearch for articles by this author Show More University of South Florida College of Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FLUniversity of Albany College of Medicine, Albany, NYChairman, ASCO Colony-Stimulating Factor Guideline Expert Panel, Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK https://doi.org/10.1200/JCO.2001.19.5.1583 First Page Full Text PDF Figures and Tables © 2001 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyResponse01032001In Reply:We appreciate the favorable response of Drs Balducci and Lyman to our article updating the American Society of Clinical Oncology's (ASCO's) hematopoietic growth factor guidelines. In addition, we fully concur with their suggestion that, in settings in which the risk of febrile neutropenia after chemotherapy exceeds 40%, primary prophylaxis with hematopoietic growth factors is now the standard of care. That setting clearly applies in those studies cited by Balducci and Lyman, which focussed on patients over age 70 receiving moderate-dose chemotherapy, primarily CHOP or CHOP-like regimens for non-Hodgkin's lymphoma.As noted in the 2000 update of the guidelines, such patients may fall under the category of "special circumstances" and would therefore be considered for primary prophylaxis with any chemotherapy regimen likely to cause myelosuppression, especially when administered with curative intent.1 This category of "special circumstances" is not meant to be restrictive, but rather to encourage clinical judgment by the treating oncologist who has the experience to recognize those individuals and chemotherapy regimens most likely to lead to life-threatening febrile neutropenia among his or her patient population.Balducci and Lyman emphasize that the proportion of patients over age 70 is steadily increasing, and that the incidence of some tumors, such as non-Hodgkin's lymphoma, is increasing as well. Coupled with the development of novel myelosuppressive agents and the tendency to diagnose and treat more such patients with curative intent than in past decades, it is evident that a steadily growing elderly population of cancer patients is at risk for febrile neutropenia and therefore would be excellent candidates for primary prophylaxis with hematopoietic growth factors, as recommended in the 2000 ASCO guidelines.REFERENCE1. Ozer H, Armitage JO, Bennett CL, et al: 2000 update of recommendations for the use of hematopoietic colony-stimulating factors: Evidence-based, clinical practice guidelines. J Clin Oncol 18:: 3558,2000-3585, Link, Google Scholar