Colony stimulating factors for prophylaxis of chemotherapy-induced neutropenia in children

ABSTRACT

Introduction

Febrile neutropenia (FN) is one of the complications of chemotherapy that can increase the risk of infection and mortality. Granulocyte colony-stimulating factors (G-CSFs) are used in practice to prevent and treat episodes of neutropenia. The use of G-CSFs in children with cancer has not been studied much for primary prophylaxis of FN.

Areas covered

Current data suggest that G-CSFs have a similar pharmacokinetic profile in children and adults. Clinical trials published from 2002 to 2021 using G-CSFs in pediatric cancer patients were reviewed. All evaluated clinical trials used a dosage of 5 mcg/kg of filgrastim daily until neutrophil recovery or a single dose of 100 mcg/kg pegfilgrastim. Filgrastim demonstrated the benefit in decreasing the duration of fever, hospital stay, and antibiotic use in high-risk neuroblastoma patients. Pegfilgrastim showed similar efficacy in reducing the occurrence of FN and infections, with bone pain as an adverse effect.

Expert opinion

Filgrastim 5 mcg/kg/day or pegfilgrastim 100 mcg/kg single dose is appropriate when given at least 24 hours or after the chemotherapy in pediatric patients who weigh 45 kg or more. More prospective randomized trials are necessary to further investigate the efficacy and safety of G-CSFs in children with different types of cancer.

KEYWORDS:

• Chemotherapy-induced neutropenia
• febrile neutropenia
• granulocyte colony stimulating factors
• G-CSF
• GM-CSF
• pediatric cancer

Article highlights

• Delayed administration of pegfilgrastim was associated with similar efficacy in neutrophil recovery while reducing the number of G-CSF injections.

• Most of the reviewed studies had patients with a median age of 10 years or older and the pharmacokinetic profiles were consistent with the general adult population.

• Filgrastim and pegfilgrastim had at least a similar efficacy in reducing neutropenic episodes in cancer pediatric patients receiving intensive chemotherapy.

• Some studies showed that filgrastim lowered the number of FN episodes, duration of FN, resolution of fever, or hospital readmission rates.

• Data on the efficacy of filgrastim and pegfilgrastim are inconsistent throughout the reviewed clinical trials.

• The most reported adverse event of G-CSFs was bone pain.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

H Kim edited, researched, and completed the original draft. SA Mousa provided guidance throughout the whole process of building up the messages and finalized the drafted article.

Additional information

Funding

This paper was not funded.