1
|
Parikh RC, Du XL, Robert MO, Lairson DR. Cost-Effectiveness of Treatment Sequences of Chemotherapies and Targeted Biologics for Elderly Metastatic Colorectal Cancer Patients. J Manag Care Spec Pharm 2017; 23:64-73. [PMID: 28025930 PMCID: PMC10397948 DOI: 10.18553/jmcp.2017.23.1.64] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Treatment patterns for metastatic colorectal cancer (mCRC) patients have changed considerably over the last decade with the introduction of new chemotherapies and targeted biologics. These treatments are often administered in various sequences with limited evidence regarding their cost-effectiveness. OBJECTIVE To conduct a pharmacoeconomic evaluation of commonly administered treatment sequences among elderly mCRC patients. METHODS A probabilistic discrete event simulation model assuming Weibull distribution was developed to evaluate the cost-effectiveness of the following common treatment sequences: (a) first-line oxaliplatin/irinotecan followed by second-line oxaliplatin/irinotecan + bevacizumab (OI-OIB); (b) first-line oxaliplatin/irinotecan + bevacizumab followed by second-line oxaliplatin/irinotecan + bevacizumab (OIB-OIB); (c) OI-OIB followed by a third-line targeted biologic (OI-OIB-TB); and (d) OIB-OIB followed by a third-line targeted biologic (OIB-OIB-TB). Input parameters for the model were primarily obtained from the Surveillance, Epidemiology, and End Results-Medicare linked dataset for incident mCRC patients aged 65 years and older diagnosed from January 2004 through December 2009. A probabilistic sensitivity analysis was performed to account for parameter uncertainty. Costs (2014 U.S. dollars) and effectiveness were discounted at an annual rate of 3%. RESULTS In the base case analyses, at the willingness-to-pay (WTP) threshold of $100,000/quality-adjusted life-year (QALY) gained, the treatment sequence OIB-OIB (vs. OI-OIB) was not cost-effective with an incremental cost-effectiveness ratio (ICER) per patient of $119,007/QALY; OI-OIB-TB (vs. OIB-OIB) was dominated; and OIB-OIB-TB (vs. OIB-OIB) was not cost-effective with an ICER of $405,857/QALY. Results similar to the base case analysis were obtained assuming log-normal distribution. Cost-effectiveness acceptability curves derived from a probabilistic sensitivity analysis showed that at a WTP of $100,000/QALY gained, sequence OI-OIB was 34% cost-effective, followed by OIB-OIB (31%), OI-OIB-TB (20%), and OIB-OIB-TB (15%). CONCLUSIONS Overall, survival increases marginally with the addition of targeted biologics, such as bevacizumab, at first line and third line at substantial costs. Treatment sequences with bevacizumab at first line and targeted biologics at third line may not be cost-effective at the commonly used threshold of $100,000/QALY gained, but a marginal decrease in the cost of bevacizumab may make treatment sequences with first-line bevacizumab cost-effective. Future economic evaluations should validate the study results using parameters from ongoing clinical trials. DISCLOSURES This study was supported in part by a grant from the Agency for Healthcare Research and Quality (R01-HS018956) and in part by a grant from the Cancer Prevention and Research Institute of Texas (RP130051), which were obtained by Du. The authors report no conflicts of interest. Study concept and design were primarily contributed by Parikh, along with the other authors. All authors participated in data collection, and Parikh took the lead in data interpretation and analysis, along with Lairson and Morgan, with assistance from Du. The manuscript was written primarily by Parikh, along with Lairson, Morgan, and Du, and revised by Parikh.
Collapse
Affiliation(s)
- Rohan C. Parikh
- RTI Health Solutions, Research Triangle Park, North Carolina, and Division of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston
| | - Xianglin L. Du
- Division of Management, Policy, and Community Health and Division of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston
| | - Morgan O. Robert
- Division of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston
| | - David R. Lairson
- Division of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston
| |
Collapse
|
2
|
Impact of Hematopoietic Growth Factors on Blood Transfusion Needs, Incidence of Neutropenia, and Overall Survival Among Elderly Advanced Ovarian Cancer Patients Treated With Chemotherapy. Int J Gynecol Cancer 2016; 26:95-103. [PMID: 26509851 DOI: 10.1097/igc.0000000000000564] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of erythropoietin-stimulating agent (ESA) and granulocyte colony-stimulating factor (CSF) in reducing blood transfusion needs and neutropenia incidence in community-dwelling elderly ovarian cancer patients. METHODS The SEER (Surveillance Epidemiology and End Results)-Medicare database was used to identify 5572 women with stage III/IV ovarian cancer who received chemotherapy. To assess clinical effectiveness, we categorized patients based on the number of administrations of ESA (ie, epoetin-alfa and darbepoetin-alfa) and CSF (ie, filgrastim and pegfilgrastim). To evaluate effect on survival, patients were categorized as receiving ESA only, CSF only, ESA + CSF, and no ESA/CSF. RESULTS Two thirds of patients received growth factor support (24% ESA only, 13% CSF only, 30% ESA + CSF). Depending on the number of epoetin-alfa administrations, ESA was associated with 48% to 56% lower need for blood transfusion compared with no ESA (hazard ratio for 1-3 claims, 0.47; 4-6 claims, 0.52; 7-10 claims, 0.48; ≥11 claims, 0.44). Patients who received at least 3 prophylactic filgrastim administrations had 71% to 98% lower risk of developing neutropenia (hazard ratio for 3-4 claims, 0.29; ≥5 claims, 0.02) compared with those without CSF. Effectiveness was comparable for darbepoetin-alfa and pegfilgrastim use. Overall survival was longer in those who received CSF only; however, the risk of mortality after 24 months was higher in those who received ESA (P = 0.0005). All models were adjusted for relevant covariates. CONCLUSIONS Erythropoietin-stimulating agents were effective in reducing blood transfusion need. Granulocyte colony-stimulating factors were effective in lowering neutropenia incidence and also were associated with improved survival in elderly ovarian cancer patients. Findings are consistent with clinical trials and clinical guidelines.
Collapse
|
3
|
Du XL, Zhang Y, Hardy D. Associations between hematopoietic growth factors and risks of venous thromboembolism, stroke, ischemic heart disease and myelodysplastic syndrome: findings from a large population-based cohort of women with breast cancer. Cancer Causes Control 2016; 27:695-707. [PMID: 27059219 DOI: 10.1007/s10552-016-0742-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/29/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine the risk of venous thromboembolism (VTE), stroke, ischemic heart disease, and myelodysplastic syndrome (MDS) in association with the receipt of colony-stimulating factors (CSFs) and/or erythropoiesis-stimulating agents (ESAs) in women with breast cancer. METHODS We studied 77,233 women with breast cancer aged ≥65 in 1992-2009 from the Surveillance, Epidemiology, and End Results-Medicare linked data with up to 19 years of follow-up. RESULTS Incidence of VTE increased from 9 cases in women receiving no chemotherapy and no CSFs/ESAs to 22.79 cases per 1,000 person-years in those receiving chemotherapy with CSFs and ESAs. Women with chemotherapy who received both CSFs and ESAs (adjusted hazard ratio and 95 % confidence interval 2.01, 1.80-2.25) or received ESAs without CSFs (2.03, 1.74-2.36) were twice as likely to develop VTE than those receiving no chemotherapy and no CSFs/ESAs, whereas those receiving CSF alone without ESA were 64 % more likely to have VTE (1.64, 1.45-1.85). Risk of MDS was significantly increased by fivefold in patients receiving ESA following chemotherapy. CONCLUSIONS Receipts of CSFs and ESAs were significantly associated with an increased risk of VTE in women with breast cancer. Use of ESAs was significantly associated with substantially increased risks of MDS. These findings support those of previous studies.
Collapse
Affiliation(s)
- Xianglin L Du
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX, 77030, USA. .,Center for Health Services Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Yefei Zhang
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX, 77030, USA.,Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dale Hardy
- Department of Clinical and Environmental Health Sciences, College of Allied Health Sciences, Georgia Regents University, Augusta, GA, USA
| |
Collapse
|
4
|
Elting LS, Xu Y, Chavez-MacGregor M, Giordano SH. Granulocyte growth factor use in elderly patients with non-Hodgkin's lymphoma in the United States: adherence to guidelines and comparative effectiveness. Support Care Cancer 2016; 24:2695-706. [PMID: 26797253 DOI: 10.1007/s00520-016-3079-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/03/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE The efficacy of prophylactic granulocyte colony-stimulating factors (G-CSFs) among elderly patients with non-Hodgkin's lymphoma (NHL) receiving CHOP-based chemotherapy has been demonstrated in clinical trials, and G-CSFs are recommended in guidelines. We studied guideline adherence and the effectiveness of G-CSFs in the general population. METHODS We used inpatient and outpatient claims from nationally representative databases linked to cancer information from tumor registries. Patients (N = 5884) diagnosed with NHL between 2001 and 2007 who were older than 65 years and who received CHOP-based chemotherapy were included. Adherence to guidelines was measured as the use of G-CSFs within 7 days of the first dose of chemotherapy. The measures of effectiveness were fever, infection, and death during cycle 1 of chemotherapy and time to cycle 2. Multiple-variable models of these outcomes were developed using logistic regression, controlling for demographic, clinical, and provider factors. RESULTS G-CSF use increased from 32 % in 2001 to 72 % in 2007. Patients who received G-CSFs were significantly less likely to have outpatient encounters for infection than those who did not receive early G-CSFs (35 vs 47 %; p < 0.0001). Inpatient encounters for infection were similarly prevalent among patients who did or did not receive early G-CSFs (5 vs 4 %; p = 0.2). There was no association between G-CSF use and death during cycle 1. CONCLUSIONS Adherence to guidelines increased after publication of clinical trials and exceeded 70 % after publication of guidelines. G-CSFs were effective in preventing outpatient encounters for fever or infection, but not inpatient encounters or deaths during cycle 1.
Collapse
Affiliation(s)
- Linda S Elting
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1444, Houston, TX, 77030, USA.
| | - Ying Xu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1444, Houston, TX, 77030, USA
| | - Mariana Chavez-MacGregor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1444, Houston, TX, 77030, USA
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1444, Houston, TX, 77030, USA
| |
Collapse
|
5
|
Parikh RC, Du XL, Morgan RO, Lairson DR. Patterns of Treatment Sequences in Chemotherapy and Targeted Biologics for Metastatic Colorectal Cancer: Findings from a Large Community-Based Cohort of Elderly Patients. Drugs Real World Outcomes 2016; 3:69-82. [PMID: 27747803 PMCID: PMC4819481 DOI: 10.1007/s40801-015-0059-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Over the last decade, multiple chemotherapies/targeted biologics have been approved for metastatic colorectal cancer (mCRC). However, evidence is limited with regards to the array of treatments received by mCRC patients. Objective This study examines treatment sequences (first- to third-line chemotherapy/targeted biologics) and the factors associated with first-line targeted biologics and common treatment sequences for elderly mCRC patients treated in a community setting. Methods A retrospective cohort study was conducted in mCRC patients diagnosed from January 2004 through December 2009 using the Surveillance, Epidemiology and End Results Medicare-linked database. The treatment sequences administered to elderly mCRC patients were empirically identified. Results Of 4418 mCRC patients who received treatment, 1370 (31 %) received first, second, and third line; 1164 (26 %) received first and second line; and 1884 (43 %) received only first line. The most common first line of treatment for mCRC patients was 5-fluorouracil/leucovorin + oxaliplatin (FOLFOX) + bevacizumab (23 %) and FOLFOX (23 %). 5-fluorouracil/leucovorin + irinotecan (FOLFIRI)-based regimens were commonly (22 %) administered in second line. The most common treatment sequence was first-line oxaliplatin or irinotecan followed by second-line oxaliplatin or irinotecan + bevacizumab followed by a third-line targeted biologic. Of patients who received first-line therapy, 47 % also received a targeted biologic, and the factors associated were age, comorbidity score, cancer site, geographic location, and year of diagnosis. Conclusion Elderly mCRC patients receive a multitude of treatments in various sequences. Further exploration of the comparative effectiveness of treatment sequences may yield important information for improving mCRC survival. Electronic supplementary material The online version of this article (doi:10.1007/s40801-015-0059-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Rohan C Parikh
- Division of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler Dr, RAS-E929, Houston, TX, 77030, USA.
| | - Xianglin L Du
- Division of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler Dr, RAS-E929, Houston, TX, 77030, USA.,Division of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Robert O Morgan
- Division of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler Dr, RAS-E929, Houston, TX, 77030, USA
| | - David R Lairson
- Division of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler Dr, RAS-E929, Houston, TX, 77030, USA
| |
Collapse
|
6
|
Du XL, Zhang Y. Risks of Venous Thromboembolism, Stroke, Heart Disease, and Myelodysplastic Syndrome Associated With Hematopoietic Growth Factors in a Large Population-Based Cohort of Patients With Colorectal Cancer. Clin Colorectal Cancer 2015; 14:e21-31. [PMID: 26119923 DOI: 10.1016/j.clcc.2015.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/29/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine the relationship between the receipt of colony-stimulating factors (CSFs) with erythropoiesis-stimulating agents (ESAs) and the risk of developing venous thromboembolism (VTE), stroke, heart disease, and myelodysplastic syndrome (MDS) in patients with colorectal cancer. METHODS We studied 80,925 patients diagnosed with colorectal cancer at age ≥ 65 years in 1992-2009 from the nationwide 16 areas of the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data. Cumulative incidence and the time to events Cox hazard regressions were used to explore the risks of outcomes in association with the receipt of CSFs and ESAs. RESULTS Patients who received chemotherapy (CT) with both CSF and ESA were 58% more likely to develop VTE than those who received CT without CSF and ESA (hazard ratio, 1.58; 95% confidence interval, 1.43-1.76). The risk of stroke appeared to be not associated with the use of CSF and ESA, whereas the risk of heart disease was only significantly elevated in those patients who did not receive CT but received ESA. The risk of acute myeloid leukemia or MDS was significantly increased 4- to 9-fold in patients who received ESA, regardless of receipt of CT or CSF. CONCLUSION The use of ESAs was significantly associated with a substantially increased risk of MDS in patients with colorectal cancer. The use of CSFs and ESAs was also significantly associated with a moderately increased risk of VTE and a slightly elevated risk of heart disease.
Collapse
Affiliation(s)
- Xianglin L Du
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston, TX; Center for Health Services Research, University of Texas School of Public Health, Houston, TX.
| | - Yefei Zhang
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston, TX; Department of Biostatistics, University of Texas School of Public Health, Houston, TX
| |
Collapse
|
7
|
Shen S, Krzyzanowska MK. A Decade of Research on the Quality of Systemic Cancer Therapy in Routine Care: What Aspects of Quality Are We Measuring? J Oncol Pract 2015; 11:55-61. [DOI: 10.1200/jop.2014.001564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Most studies evaluating quality of systemic cancer therapy have focused on access to cytotoxic chemotherapy in early-stage disease. Studies on other aspects of quality and in different clinical settings are needed.
Collapse
Affiliation(s)
- Shixin Shen
- University of Toronto; Institute for Clinical Evaluative Sciences; and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Monika K. Krzyzanowska
- University of Toronto; Institute for Clinical Evaluative Sciences; and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Zhang Y, Fu SS, Du XL. Increasing utilization and predictors of hematopoietic growth factors in patients diagnosed with colorectal cancer: findings from a large national population-based cohort in the USA, 1992–2009. Med Oncol 2014; 31:242. [DOI: 10.1007/s12032-014-0242-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 09/05/2014] [Indexed: 11/25/2022]
|
9
|
Weycker D, Barron R, Edelsberg J, Kartashov A, Legg J, Glass AG. Risk and consequences of chemotherapy-induced neutropenic complications in patients receiving daily filgrastim: the importance of duration of prophylaxis. BMC Health Serv Res 2014; 14:189. [PMID: 24767095 PMCID: PMC4018988 DOI: 10.1186/1472-6963-14-189] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 04/08/2014] [Indexed: 11/10/2022] Open
Abstract
Background To examine duration of daily filgrastim prophylaxis, and risk and consequences of chemotherapy-induced neutropenic complications (CINC) requiring inpatient care. Methods Using a retrospective cohort design and US healthcare claims data (2001–2010), we identified all cancer patients who initiated ≥1 course of myelosuppressive chemotherapy and received daily filgrastim prophylactically in ≥1 cycle. Cycles with daily filgrastim prophylaxis were pooled for analyses. CINC was identified based on hospital admissions with a diagnosis of neutropenia, fever, or infection; consequences were characterized in terms of hospital mortality, hospital length of stay (LOS), and CINC-related healthcare expenditures. Results Risk of CINC requiring inpatient care–adjusted for patient characteristics–was 2.4 (95% CI: 1.6-3.4) and 1.9 (1.3-2.8) times higher with 1–3 (N = 8371) and 4–6 (N = 3691) days of filgrastim prophylaxis, respectively, versus ≥7 days (N = 2226). Among subjects who developed CINC, consequences with 1–3 and 4–6 (vs. ≥7) days of filgrastim prophylaxis were: mortality (8.4% [n/N = 10/119] and 4.0% [3/75] vs. 0% [0/34]); LOS (means: 7.4 [N = 243] and 7.1 [N = 99] vs. 6.5 [N = 40]); and expenditures (means: $18,912 [N = 225] and $14,907 [N = 94] vs. $13,165 [N = 39]). Conclusions In this retrospective evaluation, shorter courses of daily filgrastim prophylaxis were found to be associated with an increased risk of CINC as well as poorer outcomes among those developing this condition. Because of the limitations inherent in healthcare claims databases specifically and retrospective evaluations generally, additional research addressing these limitations is needed to confirm the findings of this study.
Collapse
Affiliation(s)
- Derek Weycker
- Policy Analysis Inc, (PAI), Four Davis Court, Brookline, MA, USA.
| | | | | | | | | | | |
Collapse
|
10
|
Choi MR, Solid CA, Chia VM, Blaes AH, Page JH, Barron R, Arneson TJ. Granulocyte colony-stimulating factor (G-CSF) patterns of use in cancer patients receiving myelosuppressive chemotherapy. Support Care Cancer 2014; 22:1619-28. [PMID: 24492928 DOI: 10.1007/s00520-014-2121-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 01/06/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Febrile neutropenia (FN) is a common and serious complication of myelosuppressive chemotherapy. Guidelines recommend primary granulocyte colony-stimulating factors (G-CSF) prophylaxis (PPG) in patients with a high risk (HR, >20 %) of developing FN. We performed a retrospective analysis using a subset of the Medicare 5 % database to assess patterns of G-CSF use and FN occurrence among elderly cancer patients receiving myelosuppressive chemotherapy. METHODS Chemotherapy courses for patients aged 65+ years were identified; only the first course was used for this analysis. Using clinical guidelines, chemotherapy regimens were classified as HR or intermediate risk (IR) for FN. The first administration of G-CSF was classified as either PPG (within the first 5 days of the first cycle), secondary prophylaxis, or reactive. RESULTS Twelve thousand seven hundred seven courses across five tumor types were classified as having a HR or IR regimen. G-CSF was used in 24.5-73.8 % of patients receiving a HR FN regimen, with the highest use in breast cancer or NHL. Except for breast cancer (where PPG was used in 52.1 %), PPG was given in less than half of patients receiving a HR regimen. Depending on the tumor type, 4.8-22.6 % of patients with a HR regimen had a neutropenia-related hospitalization. CONCLUSIONS Guidelines recommend PPG with HR FN regimens and older age (>65 years), an important risk factor for developing severe neutropenic complications. However, our results show that in this elderly population, PPG was not routinely used (range 4.8-52.1 %) in patients receiving HR FN regimens. Careful attention to FN risk factors, including chemotherapy regimen and patient age, is needed when planning treatment strategies.
Collapse
Affiliation(s)
- Mi Rim Choi
- Amgen Inc., One Amgen Center Drive, M/S 17-1-A, Thousand Oaks, CA, 91320, USA
| | | | | | | | | | | | | |
Collapse
|
11
|
Extermann M, Wedding U. Comorbidity and geriatric assessment for older patients with hematologic malignancies: A review of the evidence. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2011.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
12
|
Page AV, Liles WC. Colony-stimulating factors in the prevention and management of infectious diseases. Infect Dis Clin North Am 2011; 25:803-17. [PMID: 22054757 DOI: 10.1016/j.idc.2011.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Colony-stimulating factors (CSFs) are attractive adjunctive anti-infective therapies. Used to enhance innate host defenses against microbial pathogens, the myeloid CSFs increase absolute numbers of circulating innate immune effector cells by accelerating bone marrow production and maturation, or augment the function of those cells through diverse effects on chemotaxis, phagocytosis, and microbicidal functions. This article summarizes the evidence supporting the accepted clinical uses of the myeloid CSFs in patients with congenital or chemotherapy-induced neutropenia, and presents an overview of proposed and emerging uses of the CSFs for the prevention and treatment of infectious diseases in other immunosuppressed and immunocompetent patient populations.
Collapse
Affiliation(s)
- Andrea V Page
- Division of Infectious Diseases, Department of Medicine and SA Rotman Laboratories, McLaughlin-Rotman Centre for Global Health, Toronto General Hospital, University Health Network, University of Toronto, 13 Eaton North, Room 208, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | | |
Collapse
|
13
|
Bibliography. Lymphoma. Current world literature. Curr Opin Oncol 2011; 23:537-41. [PMID: 21836468 DOI: 10.1097/cco.0b013e32834b18ec] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|