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Expert insight: The basic medical understanding of neutropenia and general clinical considerations

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Published: 03.07.18
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Dr Matti Aapro - Genolier Cancer Center, Genolier, Switzerland

Prof Matti Aapro, offers his perspectives on neutropenia from the 2018 Multinational Association of Supportive Care in Cancer (MASCC) conference in Vienna, Austria.

Providing definitions for each, Prof Aapro notes how both febrile neutropenia and neutropenia are relatively common events across various cancer treatments including radiotherapy, chemotherapy and more recently CDK4/6 inhibitors.

If managed effectively, neutropenia should have limited impact on patients, however what is necessary to consider is the length of the neutropenia and the risk of febrile neutropenia.

In some instances, this can lead to patients not being dosed with adequate amounts of chemotherapy, meaning that in patients with chemo-sensitive tumours, their treatment becomes ineffective.

When preventing febrile neutropenia, guidelines categorise patients into low (20% risk) groups.

Whilst acting as a guide, it is stressed that individualisation of treatment approaches must be considered as there are clear examples of patients with intermediate risk who should receive preventive treatment.

Prof Aapro mentions the current availability of short and long-acting G-CSFs to treat febrile neutropenia.

However, several barriers to effective management are highlighted such as lack of physician awareness and cost. It is also noted that despite the thoughts of ESMO and EORTC committees in Europe, limitations are imposed in some countries regarding treatment pathways, which could be putting patients at risk.

Prof Aapro provides some closing thoughts around the future of neutropenia and its associated treatment, whilst stressing that antibiotic use for the prevention of neutropenia is not recommended across all guidelines.

Supported by the grant of Teva Pharmaceutical Industries Ltd

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