Prospective and randomized comparison of early versus delayed prophylacticadministration of granulocyte colony-stimulating factor (filgrastim) in children with cancer

Background. The prophylactic use of hematopoietic growth factors has been s hown to reduce the duration of neutropenia and related complications encoun tered after anticancer chemotherapy. However, the optimal timing for initia tion of granulocyte colony-stimulating factor (G-CSF) has not been establis hed. Procedure. We evaluated the clinical parameters of the early versus de layed stare (+1 day vs. +5 days postchemotherapy) of filgrastim (G-CSF; 5 m u g/kg) after 36 courses of anticancer chemotherapy in 18 children with can cer in randomized fashion. Each child received two identical anticancer che motherapeutic courses followed by one early (group 1) and one delayed (grou p 2) administration of C-CSF. Filgrastim was administered until absolute ne utrophil count (ANC) exceeded 1.0 x 10(9)/l. Results. The mean duration of C-CSF therapy was 8.6 (range, 5-14) days in group 1 and 5.4 (range, 3-10) d ays in group 2 (P = 0.001). The mean duration of neutropenia (ANC < 1.0 x 1 0(9)/l) did not differ between the study groups (7.8 vs. 8.2 days). Seven i nfection episodes occurred in group 1 and eight in group 2, respectively. T he mean number of hospital days on broad-spectrum antibiotics was 2.3 (rang e, 0-8) in group 1 and 3.3 (range, 0-11) in group 2 (ns). Conclusions. We c onclude that the delayed start of filgrastim reduced the costs of this trea tment, but was not followed by more prolonged neutropenia or febrile neutro penias. Med. Pediatr. Oncol. 32:326-330, 1999. (C) 1999 Wiley-Liss, Inc.