期刊
CLINICAL INFECTIOUS DISEASES
卷 74, 期 4, 页码 567-574出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciab534
关键词
COVID-19; granulocyte colony stimulating factor; cancer; neutropenia
资金
- National Institutes of Health/National Cancer Institute (NIH/NCI) Cancer Center Support grant [P30 CA008748]
- Memorial Sloan Kettering Cancer Center K12 Paul Calabresi Career Development Award for Clinical Oncology
- Parker Institute for Cancer Immunotherapy at Memorial Sloan Kettering Cancer Center
- Sawiris Foundation
- Society of Memorial Sloan Kettering Cancer Center
- MSK Cancer Systems Immunology Pilot Grant
- Empire Clinical Research Investigator Program
- Memorial Sloan Kettering Cancer Center Department of Medicine and Weill Cornell Medicine
The use of G-CSF in cancer patients with COVID-19 may increase the risk of hospitalization, respiratory failure, and death. Careful consideration should be given to the potential risks and benefits of G-CSF treatment in neutropenic cancer patients with COVID-19.
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.
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