However, in the absence of clinical data supporting maintenance of chemotherapy dose-intensity, physicians should consider chemotherapy dose reduction as an alternative to the use of CSFs. Febrile Patients For the majority of patients with febrile neutropenia, the available data do not clearly support the routine initiation of CSFs as adjuncts to antibiotic therapy. The use of CSFs together with antibiotics may be reasonable in such high-risk patients, even though the benefits of administration under these circumstances have not been definitively proved. Available data suggest the potential for similar benefits after allogeneic BMT, but these data remain less conclusive, and the routine use of CSFs following allogeneic transplantation cannot be strongly encouraged at the present time. There also may be a role for the CSFs in assisting in the recovery of patients who experience delayed or inadequate neutrophil engraftment following progenitor-cell transplantation.
Available evidence indicates that the CSFs are effective in mobilizing PBPC for transplantation.
The same doses, routes, and schedules of CSF administration mentioned in the Guidelines for CSF Dosing and Route of Administration and Guidelines for Initiation and Duration of CSF Administration should be used in the transplantation setting. Potential concerns include inhibition of chemotherapeutic activity and enhancement of toxicity. Data supporting the routine long-term continuous use of CSFs in these patients are lacking. Intermittent administration of CSFs may be considered in a subset of patients with severe neutropenia and recurrent infection. Guidelines for Use of CSFs in Patients Receiving Concurrent Chemotherapy and Irradiation CSFs should be avoided in patients receiving concomitant chemotherapy and radiation therapy.