Overview of guidelines for proper use of the G-CSF (2013 edition)

Guidelines for proper use of the G-CSF (2001 edition) by the Japan Society of Clinical Oncology have been revised the first time in 12 years. The differences between the first edition and the new one are as follows: The new guidelines (2013 edition) adopted the clinical question format, and used the level of evidence and recommendation grades, along with the Handbook of Clinical Guidelines of Minds (2007 edition). There are relatively few evidence-based randomized controlled trials (RCTs) that can inform G-CSF use in Japan at present. Thus, we had to select the evidence from RCTs conducted in Europe and the USA when setting the recommendation level. Guidelines from Europe and the USA were also referred to; however, because the incidence of febrile neutropenia (FN) is presumed to differ between Japan and the USA/Europe, the clinical trials conducted in Japan were investigated as much as possible. New chapters on topics such as biosimilars, pegfilgrastim (domestic non-release), and the dosage and method of G-CSF administration (medical insurance in Japan) were added. The chemotherapy regimen-specific incidence of FN in Japan for primary prophylactic G-CSF administration and G-CSF use in hematological malignancy were described in detail. Nurses, pharmacists, and medical doctors participated in guideline steering committee, because the new guidelines are directed at a wide range of health care workers.