July 10th, 2020

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Use of Granulocyte Colony-Stimulating Factors with Multiagent Chemotherapy for High-Risk Gestational Trophoblastic Neoplasia Decreases Neutropenic Complications and Treatment Delays
Authors:  Margaux J. Kanis, M.D., Richard A. Greendyk, M.D., Janelle Sobecki-Rausch, M.D., Megan E. Dayno, M.S., and John R. Lurain, M.D.
  OBJECTIVE: To evaluate the use of granulocyte colony-stimulating factors (G-CSFs) in preventing neutropenic complications and treatment delays in patients receiving multiagent chemotherapy for high-risk gestational trophoblastic neoplasia (GTN).

STUDY DESIGN: Twenty-five patients received multiagent chemotherapy for high-risk GTN from 2001–2016. G-CSFs were administered as secondary therapy in the EMA-CO protocol and as primary therapy in the EMA-EP, BEP, VIP, ICE, and TP/TE regimens. Patient and disease characteristics, number of chemotherapy cycles and regimens, morbidity, treatment delays, and outcomes were evaluated.

RESULTS: Twenty-one (84%) of 25 high-risk GTN patients received G-CSFs: 4 as secondary therapy in the 23 patients who received EMA-CO and 17 as primary prophylaxis in those receiving platinum-containing regimens. Only 20 (7.6%) of 264 total chemotherapy cycles were delayed due to neutropenia. Dose reductions were necessary in only 2.3% of chemotherapy cycles. Neutropenic fever was associated with 3% of chemotherapy cycles. Eight patients (32%) had minor side effects attributable to G-CSFs. Overall survival was 88%.

CONCLUSION: In treating high-risk GTN with multiagent chemotherapy regimens, G-CSFs administered secondarily after a neutropenic complication or as primary prophylaxis in patients at high risk for febrile neutropenia decreases morbidity, treatment delays, and dose reductions, resulting in improved outcomes.
Keywords:  chemotherapy, gestational trophoblastic disease, gestational trophoblastic neoplasia, neutropenia, neutropenic fever, G-CSF, granulocyte colony-stimulating factors
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