Treatment of febrile neutropenia: filgrastim and pegfilgrastim

Aim: The use of granulocyte colony-stimulating factors in the therapeutic setting of febrile neutropenia is still unknown with regard to the prophylaxis one. The aim of the present work was to collect the information about this therapeutic use found out in the studies performed since 2003. Methods: Seven electronic databases were searched in May 2012. Eligibility included works published in English, French and Spanish from 2003 on. Studies that involved the therapeutic use of filgrastim or pegfilgrastim in chemotherapy-induced febrile neutropenia were sought. Reviews, meta-analysis and works published as abstracts were excluded. The search was completed by checking the reference lists from the selected studies. Results: One of them was performed in a hospital in the Lebanon, another one in a British hospital, another was a multi-centre study in Spain and the last one was performed in Australia through an electronic survey made to cancer specialists. In the Lebanon study, 59 out of 137 granulocyte colonystimulating factors treatment courses were performed in the therapeutic setting. In the LEARN study in Spain 29.7% patients treated with daily granulocyte colony-stimulating factors used them as treatment, so did 17.3% patients receiving pegfilgrastim. 9.7% treatments with filgrastim were therapeutic in the British hospital. Finally, in Australia 27% haematologist would use granulocyte colony-stimulating factors in case 1 (low risk of medical complications). 7% oncologists would use them in their low risk case of medical complications and 9% would use them in case 2 (higher risk). The mean duration of the therapy in the different studies ranged between 4.8 and 6 days. The most frequent adverse effect was bone pain. Conclusions: The results from the present review showed that daily granulocyte colony-stimulating factors were used more than pegfilgrastim in the treatment setting, being the latter used very little and even considered an exception. Therapies were short and safe.