Chronic Lymphocytic Leukemia

Single-agent therapy does not usually mandate the use of growth factors in patients treated for chronic lymphocytic leukemias. More intense attempts of induction with combination regimens are likely to generate a higher incidence of grade 3 or 4 neutrope-nias. While randomized trials are unavailable, in a recent study administration of FAND (Fludarabine, Ara C, mitoxantrone, and dexamethasone) resulted in an incidence of more than 60% grade 3 or 4 absolute neutropenia. This study suggested that the incidence of severe neutropenia-associated pneumonias might have been reduced in patients supported by G-CSF prophylaxis, in contrast to an earlier cohort of patients treated on the same study but without administration of G-CSF.40 One randomized trial that included patients with chronic lymphocytic leukemia suggested a benefit in terms of reduced need of red cell transfusion in patients who were given erythropoi-etin. General recommendations of erythropoietin use for the treatment of postchemotherapy anemias, according to ASCO guidelines, do apply to this category of malignancies. Erythropoietin may be beneficial for patients who are receiving supportive care only. though these guidelines do not address this specific clinical scenario.41

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