2008 Minutes (PDF)

MASCC Myelosuppression Study Group Meeting
Friday, June 27, 2008
Houston, Texas
Attendees:
Jeffrey Crawford (Study Chair), Duke University Medical Center
Matti Aapro (Study Chair), Geneva, Switzerland
Anita Nirenberg, Oncology Nursing, Columbia University
Ron Feld, Medical Oncology, Princess Margaret Hospital, Toronto
Bernardo L. Rapoport, Medical Oncology
Arkom Cheirsilpa, Medical Oncology, Bangkok, Thailand
Biren Saraiya, Medical Oncology, CINJ
Cyndy King, North Carolina
Lowell Anthony, Medical Oncology, LSU
Gloria Mattiuzzi, Leukemia Specialist, MD Anderson
Maria Foudray, Leukemia Research Nurse, MD Anderson
The Myelosuppression Study Group met to discuss possible projects for the coming year. After
individual discussion by all participants, the common theme emerged around the need for better
understanding of the practice patterns and provider decision making regarding the management
of myelosuppression throughout the MASCC community. Although practice guidelines
committees have had similar guidelines developed for the use of myeloid (white blood cell)
growth factors, the implementation of these guidelines appears to be quite different within
countries and across countries. Also, the opinions regarding the use of prophylactic antibiotics
versus the use of white blood cell growth factors continues to be an area of interest.
In the arena of erythroid stimulating agents (ESAs) more divergence of opinion has developed
regarding appropriate policies and procedures to evaluate the risks and benefit of these agents
in support of the cancer chemotherapy patient. The United States, in particular, through the
FDA has developed more restrictive policies regarding these agents which are likely to become
even more restrictive in the near future, while European and other health agencies have not, as
yet, followed suit. In this whole area of controversy, very little discussion has taken place
around transfusion practices and what the risks and benefits of transfusion are as an alternative
to ESAs. Furthermore, the individual physician practice with use of transfusions seems to vary
significantly. While some of this data has been collected through ACT, Dr. Aapro feels that
there are many additional questions remaining to be resolved. Furthermore, there was
discussion regarding the integration of intravenous iron and its role in the management of
chemotherapy induced anemia.
Lastly, the area of thrombocytopenia has developed renewed interest with the development of
practice patterns around the management of thrombocytopenia, the threshold for transfusion for
thrombocytopenia, as well as the impact of platelet count on chemotherapy dosing, are all
questions the study group felt could be clarified.
As a result of this discussion, it was felt that the best initial project for the study group would be
to pursue the development of a survey instrument that could be distributed throughout the
MASCC membership to better assess the adoption of current guidelines and practices where
they are available and to develop a better database around alternatives/additions to the use of
myeloid growth factors, including transfusion practices and policies, as well as the role of
antibiotics.

There was also significant discussion about the need to understand the practices, both in the
outpatient setting, as well as inpatient setting and across the spectrum of oncology, including
both solid tumors, as well as hematologic malignancies, including acute leukemia.
Action Items:
1) Dr. Aapro will be meeting with the ACT group to explore how we might develop a survey
tool that would complement what has already been developed to provide new information.
2) A revised minutes of this meeting will be forwarded both to the attendees of the meeting,
as well as to the full list of those interested in the myelosuppression study group.
3) From this email list, we hope to identify a subgroup of physicians, pharmacists, nurses
and others interested in these issues who would want to participate in the development and
refinement of a final survey instrument.
4) The plan would be to develop a draft of such an instrument over the next few months
with potential follow up meeting to be scheduled at the ESMO meeting this fall.