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Cancer Care in Patients During COVID-19 Infection: use of hematopoietic growth factors

Objective: To communicate change in prophylaxis guidelines for cancer patients during COVID pandemic.

The National Comprehensive Cancer Network (NCCN) have issued short-term disease-specific recommendations for patients with cancer during the present Coronavirus Disease 2019 (COVID-19) pandemic regarding the use of hematopoietic growth factors.

Considerations on Cancer Care for Patients Specific to Issues with COVID-19

  • Expanding Prophylactic Use of granulocyte colony-stimulating factor (G-CSF): To minimize the risk of febrile neutropenia, increased prophylactic use of granulocyte colony-stimulating factor (G-CSF) should be considered. This will help in reducing the numbers of cases in hospitals and emergency rooms and days of hospitalization.
  • Changing Threshold for Use of G-CSF: Threshold for use of G-CSF with regimens should be changed from only high risk (greater than 20% risk of febrile neutropenia) to intermediate risk (10% to 20% risk of febrile neutropenia). The use of G-CSF may be avoided or discontinued in cases such as respiratory symptoms or infection, confirmed or suspected COVID-19 infection to avoid increased pulmonary inflammation or hypothetical risk of increasing inflammatory cytokines associated with adverse outcome.
  • Conserving Blood Supply: Restrictive threshold [hemoglobin (Hgb) levels below 7 g/dL] should be considered for red blood cells (RBCs) transfusion. For patients with cardiopulmonary or other comorbid conditions, threshold for transfusion can be increased.
  • Broadening the Use of Erythropoietin-Stimulating Agent (ESA): Use of ESA therapy +/- intravenous iron supplementation to manage anemia in cancer patients requiring blood transfusion is recommended. Administration of ESAs or iron can coincide with usual visits or blood draws. Using lowest dose of ESA (for example, hold ESA for Hgb 10 g/dL and above) to avoid transfusion is recommended to prevent an increased risk of thrombosis due to ESAs.

References The National Comprehensive Cancer Network. NCCN Short-Term Recommendations Specific to Issues with COVID-19 (SARS-CoV-2). Available from: https://www.nccn.org/covid-19/pdf/HGF_COVID-19.pdf. Accessed on Apr 30, 2020.