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What’s New in JCO

2006 Update of ASCO Practice Guideline Recommendations for the Use of White Blood Cell Growth Factors: Guideline Summary
Context
ASCO convened an Update Committee composed of the original Expert Panel and select ad hoc members to present the 2006 evidence-based clinical practice guideline update (J Clin Oncol 24:3187-3205, 2006) for the use of hematopoietic colony-stimulating factors (CSF).

4. Use of CSF to Increase Chemotherapy Dose Intensity and Dose Density
Data on using CSF to increase dose-intensity or -density chemotherapy regimens are limited. Evidence has shown that the use of CSF allows for a moderate increase in dose-dense (but not dose-intense) regimens in certain settings (e.g., nodepositive breast cancer; and possibly non-Hodgkin’s lymphoma pending confirmation of results of individual trials). This treatment approach should only be used within the constructs of a clinical trial or if supported by appropriate evidence.

Downloaded from jop.ascopubs.org on April 7, 2009 . For personal use only. No other uses without permission. Copyright © 2006 by the American Society of Clinical Oncology. All rights reserved.

Updated 2006 Recommendations
See Table 1 for a summary of the updated 2006 recommendations and specific considerations. Table A1 lists the incidence of toxicities associated with selected chemotherapy regimens.

1. Primary Prophylactic CSF Administration (first and subsequent-cycle use)
Clinical trial data support the use of CSF when the risk of febrile neutropenia (FN) is in the range of 20% or higher. This recommendation represents a departure from the 2000 update, which recommended the use of CSF when the risk of FN was 40% or higher. Most commonly used regimens have an FN risk of less than 20%. Oncologists should consider the optimal chemotherapy regimen, individual patient risk factors and treatment intention when deciding whether to use prophylactic CSF. The use of regimens that do not require CSF because of