Abstract

BOOSTING THE FIGHT: “THE ROLE OF COLONY STIMULATING FACTORS IN FEBRILE NEUTROPENIA TREATMENT”

Mahalakshmi Kancharla*, Kaarunya Gadde, Prasanna Kumari Merakanapalli, Satish Kumar Amarthaluri, Tabitha Sharon M. and Padmalatha Kantamaneni

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Abstract

Patients with Febrile Neutropenia are more vulnerable to lifethreatening infections and possibly death, especially if their severe neutropenia lasts longer than 10 to 14 days. Febrile Neutropenia [FN] is characterized by a fever above 38.5°C and an absolute neutrophil count of less than 500 cells per cubic millimetre. Neutropenia lasting six to eight days is a common side effect of most standard-dose chemotherapy regimens. Endogenous cytokines, such as interleukin-6 and tumour necrosis factor, are triggered when chemotherapy-induced leukopenia occurs. This can lead to fever even when there is no infection. The possibility of infection, however, is the main worry in a patient with febrile neutropenia. In 25 to 40 percent of patients who have never had chemotherapy, conventional chemotherapy regimens can cause febrile neutropenia (FN). To prevent potentially fatal FN, colony-stimulating factors (CSFs) like granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) are now essential. Only G-CSF is approved by the US Food and Drug Administration for use in chemotherapy-induced neutropenia. Colony-stimulating factors (CSFs) are cytokines that stimulate and expedite the production of one or more cell lines in the bone marrow. Primary prophylaxis with G-CSF, or the administration of G-CSF immediately following cycle 1 of chemotherapy, was found to reduce the risk of febrile neutropenia in patients with solid tumours by 50%, without affecting the rates of tumour response, infection-related death, early treatment-related death, or overall survival, according to several meta-analyses. The use of G-CSF has been recognized by the American Society of Clinical Oncology (ASCO) as one of the top five ways to enhance patient outcomes and cut expenses. It was advised against using G-CSF or Pegylated G-CSF for primary prophylaxis in cancer patients receiving chemotherapy if there is less than a 20% chance of chemotherapy-induced febrile neutropenia. Most frequently, Filgrastim and Peg-filgrastim are given as a preventative measure following chemotherapy regimens that are linked to a higher risk of febrile neutropenia. Filgrastim should be started 24 to 72 hours later, and Peg-filgrastim should be given once, 24 hours later. As this strategy has been proven to be safe and successful in phase 2 clinical studies, some doctors choose to start treatment on the day that chemotherapy is finished. After giving chemotherapy, although it shortened hospital stays and increased neutrophil recovery, the administration of CSF in addition to antibiotics did not affect overall mortality in patients with chemotherapy-induced febrile neutropenia. The length of neutropenia was shorter in those receiving CSFs, and they recovered from fevers faster and used antibiotics for shorter periods of time. To prevent and manage this Febrile Neutropenia, Clinical Pharmacist interventions play a vital role.

Keywords: Febrile Neutropenia [FN], Colony-Stimulating Factor [CSF], Granulocyte Colony-Stimulating Factor [G-CSF], Granulocyte-Macrophage Colony-Stimulating Factor [GM-CSF], American Society of Clinical Oncology (ASCO), National Cancer Institute (NCI), Food and Dr