of High-Risk Febrile Neutropenia: a Multicenter Randomized Trial

García-Carbonero R, Mayordomo JI, et al. Granulocyte colony-stimulating factor in the treatment of high-risk febrile neutropenia: A multicenter randomized trial. J Natl Cancer Inst. 2001;3:31-38. Febrile neutropenia is sometimes referred to as an “oncologic emergency. ” Indeed, it can carry significant morbidity and mortality, and certainly constitutes a large portion of our inpatient admissions here at CPMC. While the role of early antibiotics is well-established and crucial, adjunctive therapies including hematopoietic colony stimulating factors are more controversial. The current study aims to address this controversy. As febrile neutropenic patients are not a homogeneous group (e.g., there is a preponderance of data suggesting that low-risk patients should be treated in an outpatient setting), this study focused on the high risk category (risk factors including sepsis & poor performance status). In this multicenter randomized trial of 210 patients, the authors show that the addition of G-CSF to an antibiotic regimen for patients with fever and neutropenia leads not only to shorter duration of neutropenia, but also to reduced hospital stay and possibly to reduced costs as well. This is a very limited study however- it was open-label, unblinded, and not placebo-controlled. Patients with leukemia & those undergoing myeloablative chemotherapy were excluded as well. Mortality was similar in both the control and experimental group. Nonetheless, the study does provide support for the administration of G-CSF to high-risk solid tumor patients with fever and neutropenia. For a good Cochrane review on this literature, see Journal of Clinica