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Impact of Hematopoietic Growth Factors on Blood Transfusion Needs, Incidence of Neutropenia, and Overall Survival Among Elderly Advanced Ovarian Cancer Patients Treated With Chemotherapy
  1. Insiya B. Poonawalla, PhD*,
  2. Linda B. Piller, MD, MPH*,
  3. David R. Lairson, PhD,
  4. Wenyaw Chan, PhD and
  5. Xianglin L. Du, PhD, MB, MS*
  1. *Departments of Epidemiology, Human Genetics, and Environmental Science,
  2. Management Policy and Community Health, and
  3. Biostatistics, University of Texas Health Science Center Houston–School of Public Health, Houston, TX.
  1. Address correspondence and reprint requests to Xianglin L. Du, PhD, MB, MS, University of Texas School of Public Health, 1200 Pressler St, RAS-E631, Houston, TX 77030. E-mail:


Objective To determine the effectiveness of erythropoietin-stimulating agent (ESA) and granulocyte colony-stimulating factor (CSF) in reducing blood transfusion needs and neutropenia incidence in community-dwelling elderly ovarian cancer patients.

Methods The SEER (Surveillance Epidemiology and End Results)-Medicare database was used to identify 5572 women with stage III/IV ovarian cancer who received chemotherapy. To assess clinical effectiveness, we categorized patients based on the number of administrations of ESA (ie, epoetin-alfa and darbepoetin-alfa) and CSF (ie, filgrastim and pegfilgrastim). To evaluate effect on survival, patients were categorized as receiving ESA only, CSF only, ESA + CSF, and no ESA/CSF.

Results Two thirds of patients received growth factor support (24% ESA only, 13% CSF only, 30% ESA + CSF). Depending on the number of epoetin-alfa administrations, ESA was associated with 48% to 56% lower need for blood transfusion compared with no ESA (hazard ratio for 1-3 claims, 0.47; 4–6 claims, 0.52; 7–10 claims, 0.48; ≥11 claims, 0.44). Patients who received at least 3 prophylactic filgrastim administrations had 71% to 98% lower risk of developing neutropenia (hazard ratio for 3–4 claims, 0.29; ≥5 claims, 0.02) compared with those without CSF. Effectiveness was comparable for darbepoetin-alfa and pegfilgrastim use. Overall survival was longer in those who received CSF only; however, the risk of mortality after 24 months was higher in those who received ESA (P = 0.0005). All models were adjusted for relevant covariates.

Conclusions Erythropoietin-stimulating agents were effective in reducing blood transfusion need. Granulocyte colony-stimulating factors were effective in lowering neutropenia incidence and also were associated with improved survival in elderly ovarian cancer patients. Findings are consistent with clinical trials and clinical guidelines.

  • Erythropoietin-stimulating agent
  • Blood transfusion
  • Granulocyte colony-stimulating factor
  • Neutropenia
  • Survival
  • Ovarian cancer

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  • This study was supported in part by a grant from the Agency for Healthcare Research and Quality (R01-HS018956).

  • The authors declare no conflicts of interest.

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