The effect of neutropenia and filgrastim (G-CSF) on cancer patients with coronavirus disease 2019 (COVID-19) infection Journal Article
| Authors: | Zhang, A. W.; Morjaria, S.; Kaltsas, A.; Hohl, T. M.; Parameswaran, R.; Patel, D.; Zhou, W.; Predmore, J.; Perez-Johnston, R.; Jee, J.; Daniyan, A. F.; Perales, M. A.; Taur, Y. |
| Article Title: | The effect of neutropenia and filgrastim (G-CSF) on cancer patients with coronavirus disease 2019 (COVID-19) infection |
| Abstract: | Background Neutropenia is commonly encountered in cancer patients. Recombinant human granulocyte colony-stimulating factor (G-CSF, filgrastim), a cytokine that initiates proliferation and differentiation of mature granulocytes, is widely given to oncology patients to counteract neutropenia, reducing susceptibility to infection. However, the clinical impact of neutropenia and G-CSF use in cancer patients with coronavirus disease 2019 (COVID-19) remains unknown. Methods An observational cohort of 379 actively treated cancer patients with COVID-19 was assembled to investigate links between concurrent neutropenia and G-CSF administration on COVID-19-associated respiratory failure and death. These factors were encoded as time-dependent predictors in an extended Cox model, controlling for age and underlying cancer diagnosis. To determine whether the degree of granulocyte response to G-CSF affected outcomes, the degree of response to G-CSF, based on rise in absolute neutrophil count (ANC) 24 hours after growth factor administration, was also incorporated into a similar Cox model. Results In the setting of active COVID-19 infection, outpatient receipt of G-CSF led to an increased number of hospitalizations (hazard ratio [HR]: 3.54, 95% confidence interval [CI]: 1.25-10.0, P value: .017). Furthermore, among inpatients, G-CSF administration was associated with increased need for high levels of oxygen supplementation and death (HR: 3.56, 95% CI: 1.19-10.2, P value: .024). This effect was predominantly seen in patients that exhibited a high response to G-CSF based on their ANC increase post-G-CSF administration (HR: 7.78, 95% CI: 2.05-27.9, P value: .004). Conclusions The potential risks versus benefits of G-CSF administration should be considered in neutropenic cancer patients with COVID-19, because G-CSF administration may lead to worsening clinical and respiratory status. The safety profile of G-CSF in patients with severe SARS-CoV2 infection is unclear. Here, we systematically characterized the effect G-CSF on the risk for respiratory decompensation and death in cancer patients who were infected with COVID-19. " |
| Keywords: | neutropenia; granulocyte colony stimulating factor; cancer; covid-19 |
| Journal Title: | Clinical Infectious Diseases |
| Volume: | 74 |
| Issue: | 4 |
| ISSN: | 1058-4838 |
| Publisher: | Oxford University Press |
| Date Published: | 2022-02-15 |
| Start Page: | 567 |
| End Page: | 574 |
| Language: | English |
| ACCESSION: | WOS:000755802400001 |
| DOI: | 10.1093/cid/ciab534 |
| PROVIDER: | wos |
| PMCID: | PMC8406899 |
| PUBMED: | 34111237 |
| Notes: | Article -- Source: Wos |
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