The effect of primary granulocyte-colony stimulating factor prophylaxis on the incidence of febrile neutropenia in patients with testicular germ cell tumors

Background: Testicular germ cell tumors (GCTs) are the most common solid malignancy in men 15-35 years old. Febrile neutropenia (FN) is a grievous complication of chemotherapy, frequently occurring in GCT patients. The aim of this retrospective study was to assess the effect of primary granulocyte-colony stimulating factor (G-CSF) prophylaxis on the incidence of FN in GCT patients. Patients and methods: This study was conducted from medical records database of GCTs patients treated with first line/adjuvant chemotherapy from January 2000 to December 2017. Starting in January 2006, patients received G-CSF prophylaxis after every cycle of chemotherapy. Results: Out of 393 patients, 265 patients received primary G-CSF prophylaxis and 128 patients did not receive prophylaxis. During the study period, 71 patients (18.1%) suffered FN events. Out of 128 patients who did not receive primary prophylaxis, 42 patients suffered FN, while only 29 patients with primary prophylaxis suffered FN (32.8% vs 10.9%, P = 0.0000001). On subgroup analysis, FN incidence decreased in all groups with primary prophylaxis, except for patients with stage I GCT receiving adjuvant chemotherapy. Patients receiving G-CSF prophylaxis had significantly longer overall survival when compared to patients without prophylaxis. (HR = 0.44, 95% CI 0.26-0.75; P = 0.0009).Conclusions: Primary G-CSF prophylaxis was associated with significantly decreased FN incidence in patients treated with first line chemotherapy for metastatic disease. Patients receiving G-CSF prophylaxis had significantly longer overall survival. We suggest, that primary G-CSF prophylaxis should be considered in GCT patients receiving first line chemotherapy.