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Pediatric Hematology/Oncology • Medical Oncology • Internal Medicine • ALL • Hematology • Pediatric Hematology
What is your practice regarding giving G-CSF to patients with ALL during initial induction?
The patient was recently diagnosed with pre-B ALL and is on day 10 of CALGB 10403. He is expectedly neutropenic as he received daunorubicin and vincristine. He is on "adequate" antimicrobial prophylaxis.
ASCO guidelines say nothing about adults or AYA with ALL. The closest I could find was; "CSFs should not be used in pediatric patients with non-relapsed acute lymphoblastic leukemia (ALL) or non-relapsed acute myeloid leukemia (AML) who do not have an infection. (Type: informal consensus. Evidence quality: intermediate. Strength of recommendation: moderate.)".
Answer from: at Academic Institution
My colleagues and I do not use G-CSF in either ALL or AML unless the neutropenia is unusual and prolonged and associated with infection.
The use of G-CSF has been shown to shorten neutropenia by a few days but does not prevent the drop and theoretically, at least it may prolong thrombocytopenia by ...
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Answer from: Medical Oncologist at Academic Institution
We take a similar approach. We generally reserve G-CSF for treatment of severe neutropenia with fever or documented infection, which is not particularly common with this regimen.
An example of the evidence alluded to by Dr. @Weitzman is the CALGB 9111 trial (Larson et al., PMID 9716583). This was a...