Supportive Care: CSFs in Febrile Neutropenia

Question 1

Febrile neutropenia definition

Answer 1

single temperature ≥38.3ºC PO or ≥38ºC over 1 hour PLUS ANC <500 cells/mm3 or expected to decrease to <500 cells/mm3 in 48 hours

Question 2

FN risk factors

Answer 2

Disease
High-dose, dose-dense therapy
Patient risk factors

Question 3

Patient risk factors for FN

Answer 3

prior chemo or radiation
persistent neutropenia
bone marrow involvement by tumor
recent surgery and/or open wounds
liver dysfunction (bilirubin >2.0mg/dl)
renal dysfunction (CrCl <50ml/min)
age >65 receiving full chemo dose intensity

Question 4

Growth factors place in FN therapy

Answer 4

Primary prevention
Treatment
Secondary prevention

Question 5

Growth factors in primary prevention: when is it recommended?

Answer 5

high (>20%) risk of FN, regardless of patient risk factors

Question 6

Growth factors in primary prevention: when is it considered?

Answer 6

intermediate (10-20%) risk of FN AND ≥1 risk factor

Question 7

Growth factors in primary prevention: when it MAY BE considered

Answer 7

low (10-20%) risk and ≥2 risk factors

Question 8

G-CSF treatment options

Answer 8

Filgrastim, tba-filgrastim
Pegfilgrastim
Elfapegrastim-xnst

Question 9

Short-acting G-CSF

Answer 9

Filgrastim, tba-filgrastim

Question 10

Long-acting G-CSFs

Answer 10

Pegfilgrastim, elfapegrastim-xnst

Question 11

When to administer filgrastim/tbo-filgrastim

Answer 11

Next day or up to 3-4 days after chemo; give QD until ANC recovery

Question 12

When to administer pegfilgrastim

Answer 12

Up to 3-4 days after chemo completion, single administration

Allow ≥12 days between dose and next chemo cycle

Question 13

When to administer eflapegrastim-xnst

Answer 13

> 24hrs after chemo completion as a single administration

Don’t administer 14 days before and 24 hours after chemo administration

Question 14

FN treatment and G-CSFs: patient received filgrastim prophylactically

Answer 14

Continue filgrastim

Question 15

FN treatment and G-CSFs: patient received pegfilgrastim or eflapegrastim-xnst prophylactically

Answer 15

No more G-CSFs needed

Question 16

FN treatment and G-CSFs: no prophy G-CSFs

Answer 16

Assess risk factors for infection-associated complication

Question 17

Possible indications for G-CSF in established FN

Answer 17

sepsis syndrome, age >65, ANC <100 cells/mm^3, neutropenia expected to be >10 days in duration, pneumonia or other clinically documented infections, invasive fungal infection, hospitalization at the time of fever, prior episode of FN

Question 18

Secondary prevention for FN: prior use of G-CSFs

Answer 18

Consider chemo dose reduction or change treatment regimen