Neulasta or Neupogen for elderly patients
Standard guidelines recommend prophylactic Neulasta or Neupogen for patients who are treated with chemotherapy regimens that produce a greater than 20% risk of febrile neutropenia. These guidelines based themselves on the regimens and their risk and do not apply to the elderly. Elderly patients are at a higher risk of fever and low white counts following chemotherapy, with a greater chance of dying form it, than younger patients. It stands to reason that they should receive prophylactic treatment for low white counts for regimens that are otherwise well tloerated by the younger patient. Unfortunately, until recently this question had not been well explored because clinical trials routinely excluded the elderly. More recent studies found the that sue of prophylactic Neualsta or Neupogen lassociated with reductions in in-hospital admissions and more recent reviews recommend it. It would be fair to say that the field is shifting toward generally recommending prophylactic growth factors in the elderly.
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