Results of a prospective dose intensity and neutropenia prophylaxis evaluation programme (DIEPP) in cancer patients at risk of febrile neutropenia due to myelosuppressive chemotherapy

Wien Klin Wochenschr. 2016 Apr;128(7-8):238-47. doi: 10.1007/s00508-015-0917-1. Epub 2016 Jan 8.


Objective: To describe the incidence of febrile neutropenia (FN) and use of pegfilgrastim in cancer patients with high overall risk of FN and to investigate the relationship between granulocyte-colony stimulating factor (G-CSF) guideline adherence and chemotherapy delivery in Central and Eastern Europe (CEE) and Austria.

Methods: Dose Intensity Evaluation Program and Prophylaxis (DIEPP) was a multicentre, prospective, and observational study of adult patients with breast cancer, lymphoma, lung cancer, gastric cancer, and ovarian cancer, who received chemotherapy with pegfilgrastim support and who had an overall risk of FN ≥ 20 %. Physicians assessed patient risk factors and reported their reasons for administering pegfilgrastim.

Results: Patients were enrolled from 113 centres in CEE and Austria between August 2010 and July 2013, and data were analysed from 1072 patients. The most common tumour types were breast cancer (50 %) and lymphoma (24 %). FN incidence was 5 % overall. FN occurred in 3 % of patients (28/875) who received pegfilgrastim as primary prophylaxis (PP) and 13 % of patients (19/142) who received it as secondary prophylaxis (SP); 79 % of FN events in SP patients occurred in the first cycle before pegfilgrastim was administered. The three most frequently chosen reasons for using pegfilgrastim were planned chemotherapy with high FN risk, female gender, and advanced disease. Overall, 40 % of patients received > 90 % of their planned chemotherapy dose within 3 days of the planned schedule.

Conclusion: FN incidence was relatively low with pegfilgrastim PP in patients with a physician-assessed overall FN risk of ≥ 20 %. The most important reasons for pegfilgrastim use were consistent with the investigators' risk assessment and international guidelines.

Keywords: Chemotherapy; Febrile neutropenia; Granulocyte colony-stimulating factor; Neoplasms; Observational study.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Austria / epidemiology
  • Chemotherapy-Induced Febrile Neutropenia / epidemiology
  • Chemotherapy-Induced Febrile Neutropenia / prevention & control*
  • Dose-Response Relationship, Drug
  • Europe, Eastern / epidemiology
  • Female
  • Filgrastim
  • Granulocyte Colony-Stimulating Factor / administration & dosage*
  • Granulocyte Colony-Stimulating Factor / standards
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Neoplasms / drug therapy*
  • Neoplasms / epidemiology*
  • Neutropenia / epidemiology
  • Neutropenia / prevention & control*
  • Polyethylene Glycols
  • Recombinant Proteins / administration & dosage
  • Recombinant Proteins / standards
  • Risk Factors
  • Treatment Outcome


  • Recombinant Proteins
  • Granulocyte Colony-Stimulating Factor
  • pegfilgrastim
  • Polyethylene Glycols
  • Filgrastim