Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)
Evidence-based AGIHO guideline update on prophylaxis of infectious complications with granulocyte-stimulating factors (G-CSF) for the treatment of adult patients with cancer
This guideline holds 10 recommendations, 94 references and 5 tables.
Summary
Febrile neutropenia (FN) is an important complication of cancer treatment. This updated evidence-based guideline provides recommendations for the prophylactic use of G-CSF to reduce the risk of FN in adult cancer patients, addressing changes in antineoplastic treatments such as immunotherapy over the past decade.
Key takeaways
Hodgkin lymphoma: BrECADD or BV+AVD are new standard immunochemotherapy protocols and should be complemented with G-CSF.
AML: G-CSF is safe in the treatment of AML and should be considered regarding the shortening of neutropenia and duration of hospitalization.
Treatment with T cell engager products: G-CSF administration in neutropenia after CAR T cell therapy and bispecific antibody treatment is safe.
Biosimilar G-CSF is at least non-inferior compared to originator G-CSF in terms of efficacy and survival and is a cost-effective alternative.
Efbemalenograstim alfa is at least non-inferior compared to pegfilgrastim or filgrastim in terms of efficacy.
G-CSF for primary prophylaxis can help to save antibiotics.
What is new in this version
Updated the 2014 AGIHO guideline to provide a comprehensive analysis of literature since 2014, including new recommendations on the use of G-CSF in immunotherapy settings (CAR T cells and bispecific antibodies), new immunochemotherapy protocols (BrECADD, BV+AVD), and the use of biosimilars and efbemalenograstim alfa.
Recommendations
6. G-CSF in the treatment of non-Hodgkin lymphoma
It is recommended to administer G-CSF on days 2–4 after completing cytotoxic treatment rather than on the same day as chemotherapy to avoid an increase in febrile neutropenia.
Population: Patients with non-Hodgkin lymphoma and solid tumorsWhen: Chemotherapy-induced neutropenia
7. G-CSF in the treatment of Hodgkin lymphoma
Primary G-CSF prophylaxis is not routinely recommended in patients with Hodgkin lymphoma undergoing ABVD 1st line treatment but might be a clinically valid supportive option in selected patients with advanced age or relevant comorbidities.
Population: Patients with Hodgkin lymphoma undergoing ABVDWhen: Hodgkin lymphoma
Primary G-CSF prophylaxis is recommended for both younger and elderly patients receiving BV+AVD as first-line treatment for advanced (stage III/IV) HL.
Population: Elderly patients and those with comorbidities receiving BV+AVDWhen: Advanced Hodgkin lymphoma
Prophylactic G-CSF should be given in all patients with HL undergoing escalated BEACOPP or BrECADD therapy.
Population: Patients with Hodgkin lymphoma undergoing escalated BEACOPP or BrECADDWhen: Hodgkin lymphoma
8. G-CSF in the treatment of acute leukemia
G-CSF shows effects on the reduction of neutropenia and a benefit regarding infections for patients undergoing medium-intensity consolidation with high-dose cytarabine (≥60 years) and should be considered to shorten hospitalization.
Population: AML patients ≥60 years undergoing medium-intensity consolidationWhen: Acute myeloid leukemia
9. Secondary application of G-CSF
Secondary application of G-CSF is recommended after a neutropenic complication in the previous cycle has occurred.
Population: Patients with cancer who experienced a neutropenic complication in a previous cycleWhen: Neutropenic complication
10. G-CSF after CAR T cell therapy
We recommend the use of G-CSF in neutropenia after CAR-T cell treatment.
Population: Patients with neutropenia after CAR T cell therapyWhen: Neutropenia
11. G-CSF after treatment with bispecific antibodies (BsAb)
G-CSF should not be administered during step-up dosing or during cytokine release syndrome (CRS).
Population: Patients receiving bispecific antibodiesWhen: Cytokine release syndrome (CRS)
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