Colony-Stimulating Factor Medicines Slightly Lower Hospitalizations for Low White Blood Cell Counts

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Chemotherapy is the breast cancer treatment most likely to weaken the immune system. Chemotherapy medicines target rapidly dividing cells, which cancer cells are -- but so are many of the normal cells in your blood, bone marrow, mouth, intestinal tract, nose, nails, vagina, and hair. So chemotherapy affects them, too.

As chemotherapy medicines damage the bone marrow, the marrow is less able to produce enough red blood cells, white blood cells, and platelets. Typically, the greatest impact is on white blood cells. When you don’t have enough white blood cells, your body is more vulnerable to infection. Certain white blood cells, called neutrophils, are especially important because they’re the first responders to infection and gobble up bacteria and germs.

A normal neutrophil count is around 1,500. If the count is lower than that you have a condition called neutropenia, which greatly raises your risk of a serious infection.

To help prevent neutropenia, doctors can prescribe medicines called colony-stimulating factors or white blood cell growth factors to be given along with chemotherapy treatments. These medicines can help the body produce more neutrophils and other types of white blood cells. Examples of colony-stimulating factor (CSF) medicines include:

A study has found that CSF medicines modestly reduce a woman’s risk of being hospitalized for neutropenia while being treated with certain chemotherapy regimens.

The research was published online on Sept. 19, 2016 by the Journal of Clinical Oncology. Read the abstract of "Risk of Neutropenia-Related Hospitalization in Patients Who Received Colony-Stimulating Factors With Chemotherapy for Breast Cancer."

Doctors know that certain chemotherapy regimens have a higher risk of causing neutropenia than other regimens.

In this study, the researchers looked at the medical records of 8,745 women who were diagnosed with breast cancer from 2008 to 2013 and treated with chemotherapy:

  • 4,815 women were treated with Taxotere (docetaxel) and Cytoxan (chemical name: cyclophosphamide)
  • 2,292 women were treated with Taxotere, carboplatin (brand name: Paraplatin), and Herceptin (chemical name: trastuzumab)
  • 1,638 women were treated with Adriamycin (chemical name: doxorubicin) and Cytoxan

The Taxotere-Cytoxan and Taxotere-carboplatin-Herceptin regimens have a low-to-intermediate risk of causing neutropenia. The Adriamycin-Cytoxan regimen has a low risk of causing neutropenia.

Most of the women in each treatment group also received a CSF medicine within 5 days of starting chemotherapy:

  • 2,849 women treated with Taxotere and Cytoxan got a CSF medicine
  • 1,444 women treated with Taxotere, carboplatin, and Herceptin got a CSF medicine
  • 857 women treated with Adriamycin and Cytoxan got a CSF medicine

Neulasta was the most commonly used CSF medicine, given to:

  • 96% of the women treated with Taxotere and Cytoxan
  • 98% of the women treated with Taxotere, carboplatin, and Herceptin
  • 95% of the women treated with Adriamycin and Cytoxan

The researchers found that women treated with Taxotere and Cytoxan and women treated with Taxotere, carboplatin, and Herceptin who also got a CSF medicine had a lower risk of being hospitalized for neutropenia compared to women on the same regimens who didn’t get a CSF medicine. This lower risk was statistically significant, which means that it was likely because of the CSF medicine and not just due to chance.

For women treated with Taxotere and Cytoxan:

  • 2% of women also treated with a CSF medicine were hospitalized for neutropenia
  • 7.1% of women who didn’t get a CSF medicine were hospitalized for neutropenia

For women treated with Taxotere, carboplatin, and Herceptin:

  • 1.3% of women also treated with a CSF medicine were hospitalized for neutropenia
  • 7.1% of women who didn’t get a CSF medicine were hospitalized for neutropenia

Women in the Adriamycin and Cytoxan treatment group who also got a CSF medicine had a slightly higher risk of being hospitalized for neutropenia compared to women who didn’t get a CSF medicine, but this difference wasn’t statistically significant, so it could have been due to chance.

The researchers also found that younger women were less likely to be hospitalized for neutropenia.

Even though most of the women in each treatment group also were treated with a CSF medicine, the researchers found that the CSF medicine offered only modest benefits as far as reducing the risk of being hospitalized for neutropenia. They recommended that more research be done to more precisely determine which women would benefit from CSF medicines.

If you’ve been diagnosed with breast cancer and will be treated with chemotherapy, it makes sense to talk to your doctor about your risk of neutropenia and steps you can take to prevent it. Being treated with a CSF medicine is one way to do that.

It also makes sense to check with your insurance company about any regulations it has about CSF medicine use. Some companies require that specific CSF medicines be prescribed. Other companies require that your white blood cell count must drop to below a certain level before they will pay for a CSF medicine.

For more information on neutropenia, the chemotherapy medicines that can cause it, and things to considered if you have neutropenia, visit the Breastcancer.org Low White Blood Cell Count page.



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