Einsatz von G-CSF (Neupogen®) bet multimodalen therapiekonzepten in der strahlentherapie

Background: Therapy-induced leucopenias with corresponding consequences repeatedly occur in radiotherapy using combined modalities treatment. In radiotherapy, where G-CSF (granulocyte-colony-stimulating-factor) is not licensed, G-CSF has been used successfully under individual circumstances. These results were confirmed in several studies with small patient groups. The aim of this study was to check former results in a larger patient group, to verify postulated side effects and specially to define a cost-effective schedule in the treatment with G-CSF (Neupogen®). Patients and Methods: In this surveillance trial 50, partially previously treated patients with different malignant tumors were treated with G-CSF. According to the probability of a leucocytosis lower than 1000/mm³, G-CSF (Neupogen®) was already given at leucocyte values lower than 2500/mm³ (500/mm³ bis 2450/mm³). It was administered subcutaneously, every other day, based on body weight until reaching normal leucocyte levels. Results: In 92% of the patients the increase of leucocytes occurred in the first 24 hours. On average G-CSF was given 4.9 times per patient. Patients without prior therapies or less complex therapies needed less G-CSF applications (3.5 to 5.8 applications). Due to individually varying leucocyte courses the G-CSF therapy was started with leucocyte values between 500/mm³ and 2450/mm³. Patients who were treated with up to 3 G-CSF applications had higher leucocyte levels than those with 4 or more applications (1620/mm³ to 1250/mm³). Leucopenia related infections, therapy interruptions or break- offs did not occur. Besides light 'flu like' symptoms in 14% of the patients, no side effects were observed. Conclusions: When a decrease of leucocyte values lower than 1000/mm³ is expected, the most cost-effective treatment is given when starting the interventional G-CSF administration already at leucocyte values around 1600/mm³. Leucopenias can be treated effectively, with little side effects and in a cost-effective way when G-CSF is given on time.