Outcomes/Effectiveness Research

Colony-stimulating factor is effective in reducing infection for elderly patients with non-Hodgkin's lymphoma on chemotherapy

Elderly patients with non-Hodgkin's lymphoma (NHL), who are undergoing chemotherapy, benefit from prophylactic colony-stimulating factor (CSF), concludes a new study. Most cases of NHL are diagnosed in individuals aged 65 and older. The decision to treat elderly patients with chemotherapy is not always straightforward, because the risk of febrile neutropenia (an abnormally low count of neutrophils, the white blood cells that fight infection) after myelosuppressive chemotherapy is greater in older adults. Myelosuppression (reduced bone marrow activity leading to lower production of blood cells) increases with age. Febrile neutropenia is associated with life-threatening infections. To combat this, CSF, which has been shown to reduce the incidence and duration of febrile neutropenia, is administered.

The researchers studied 13,203 elderly people diagnosed with NHL. Some were treated with CSF at the onset of chemotherapy, prior to developing febrile neutropenia (primary prophylaxis), while others were treated only after febrile neutropenia had occurred (secondary prophylaxis). Among those treated prior to developing febrile neutropenia, participants with 5 to 9 administrations of CSF had a 42 percent lower risk of febrile neutropenia and a 27 percent lower risk of infection than those without CSF. Those with 10 or more administrations had a 48 percent lower risk of febrile neutropenia and a 52 percent lower risk of infection than those without CSF. Primary prophylactic CSF was not associated with longer overall survival.

In the other group of patients who experienced neutropenia, fever, or infection, secondary prophylactic CSF was significantly associated with longer overall survival, with a strong dose-response relationship. Four to 10 administrations of CSF was associated with a 9 percent lower risk of mortality, 11 to 23 administrations with a 23 percent lower risk, and more than 23 administrations with a 13 percent lower risk than those who did not receive CSF. This study was supported by the Agency for Healthcare Research and Quality (HS16743).

See "Comparative effectiveness of white blood cell growth factors on neutropenia, infection, and survival in older people with non-Hodgkin's lymphoma treated with chemotherapy," by Stephen K. Gruschkus, Ph.D., David Lairson, Ph.D., Xianglin L. Du, M.D., Ph.D., and others in the Journal of the American Geriatric Society 58, pp. 1885-1895, 2010.

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