In what situations do you utilize G-CSF in germ cell tumors or Hodgkin lymphoma patients receiving bleomycin?

Having been both a lymphoma doctor and germ cell tumor doctor, I can tell you our experience. The current standard for poor risk germ cell tumors is to routinely include G-CSF with BEP X 4 and VIP X 4 in most high volume centers. A number of experts include growth factors routinely in good risk patients getting BEP X 3 despite the fact that good risk patients have a much lower risk of neutropenic fever than do poor risk receiving the same chemotherapy. It is done even in patients receiving one c...

I will limit my comments for patients with germ cell tumors.

Bleomycin containing combination regimens, such as BEP, are associated with intermediate (10-20%) risk of febrile neutropenia. Poor-risk germ cell tumor patients who receive higher-dose/intensity combination chemotherapy (such as 6 cycles of bleomycin containing combination chemotherapy) experience higher incidences of febrile neutropenia and complications (Foss SD, J Clin Oncol 1998). NCCN recommends observation in patients with interm...