Transfusion of granulocytes has no role in the management of febrile neutropenia, owing to their exceedingly short half-life, mechanical fragility, and clinical syndromes of pulmonary compromise with leukostasis after their use. Instead, colony-stimulating factors (CSFs) are used to augment bone marrow production of PMNs. Early-acting factors such as IL-1, IL-3, and stem cell factor, have not been as useful clinically as late-acting, lineage-specific factors such as GCSF (granulocyte colony-stimulating factor) or GM-CSF (granulocyte- macrophage colony-stimulating factor), erythropoietin (EPO), thrombopoietin, IL6, and IL-11. CSFs may easily become overused in oncology practice. . | Chapter 081. Principles of Cancer Treatment Part 20 Transfusion of granulocytes has no role in the management of febrile neutropenia owing to their exceedingly short half-life mechanical fragility and clinical syndromes of pulmonary compromise with leukostasis after their use. Instead colony-stimulating factors CSFs are used to augment bone marrow production of PMNs. Early-acting factors such as IL-1 IL-3 and stem cell factor have not been as useful clinically as late-acting lineage-specific factors such as G-CSF granulocyte colony-stimulating factor or GM-CSF granulocytemacrophage colony-stimulating factor erythropoietin EPO thrombopoietin IL-6 and IL-11. CSFs may easily become overused in oncology practice. The settings in which their use has been proved effective are limited. G-CSF GM-CSF EPO and IL-11 are currently approved for use. The American Society of Clinical Oncology has developed practice guidelines for the use of G-CSF and GM-CSF Table 81-3 . Table 81-3 Indications for the Clinical Use of G-CSF or GM-CSF Preventive Uses With the first cycle of chemotherapy so-called primary CSF administration Not needed on a routine basis Use if the probability of febrile neutropenia is 20 Use if patient has preexisting neutropenia or active infection Age 65 treated for lymphoma with curative intent or other tumor treated by similar regimens Poor performance status Extensive prior chemotherapy Dose-dense regimens in a clinical trial or with strong evidence of benefit With subsequent cycles if febrile neutropenia has previously occurred so-called secondary CSF administration Not needed after short duration neutropenia without fever Use if patient had febrile neutropenia in previous cycle Use if prolonged neutropenia even without fever delays therapy Therapeutic Uses Afebrile neutropenic patients No evidence of benefit Febrile neutropenic .
