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Recommendations on Neutropenia in Cancer Patients During COVID-19

Objective: To communicate neutropenia-related guidelines for cancer patients during COVID-19 pandemic.

The National Comprehensive Cancer Network (NCCN) has issued short-term recommendations for the use of granulocyte colony-stimulating factor (G-CSF) in cancer patients during the present Coronavirus Disease 2019 (COVID-19) pandemic.

Considerations on Cancer Care for Patients during COVID-19

  • Expanding Prophylactic Use of G-CSF: To minimize the risk of febrile neutropenia, increased prophylactic use of G-CSF should be considered. This will help in reducing the numbers of cases in hospitals and emergency rooms.
  • 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) or high risk. The use of G-CSF may be avoided or discontinued in cases such as respiratory infection or symptoms, confirmed or suspected COVID-19 infection to avoid increased pulmonary inflammation or hypothetical risk of increasing inflammatory cytokines.
  • Aim to minimize days of hospitalization: Broaden the therapeutic use if patients previously not on G-CSF develop febrile neutropenia to include all patients, not just those with a risk factor for complication.

Reference: The National Comprehensive Cancer Network. NCCN Short-Term Recommendations Specific to Issues with COVID-19 (SARS-CoV-2). Available from Accessed on Apr 30, 2020.