A Multicenter Analysis of the Outcome of Cancer Patients with Neutropenia and COVID-19 Optionally Treated with Granulocyte-Colony Stimulating Factor (G-CSF): A Comparative Analysis

Round 1

Reviewer 1 Report

A comprehensive publication on the analysis of clinical features of cancer patients with febrile neutropenia and COVID-19 optionally treated with G-CSF.

Overall, the manuscript is worth publishing.

Please find below my comments:

1. in the introduction, it is worth mentioning only the first author's surnames when citing their work.
2. Literature for the sentence "Moreover, neutrophilia and high neutrophil/lymphocyte ratio (NLR) have been described as bad prognosis factors in COVID-19 patients [15]" should be added (https://doi.org/10.3390/pathogens9060493).
3. The introduction could be cleaned up, especially the first part; it might be better to use shorter sentences and not give as many details.
4. Would you please indicate the cities where the hospitals are located?
5. The names of the software or drugs should include the manufacturer.
6. At the beginning of the results, authors should define which types of cancer they included. This is very important to the readers.
7. How was febrile neutropenia diagnosed?
8. How G-CSF was used - doses, administration schedule.
9. Table 3 is confusing - what do these mean, the highest and the lowest values?
10. The discussion must be simplified.
11. The conclusion is too general, and in light of so many results, it needs to be expanded.
12. A native speaker must proofread the manuscript.

Author Response

Please see the attachment

Thank you

Author Response File: Author Response.docx

Reviewer 2 Report

In this small retrospective non randomized study, Sereno and colleagues found an association between G-CSF treatment and higher severity of COVID19 disease.

This analysis is clinically interesting and matches with the broad range of knowledge that G-CSF might increase probability/severity of cytokine storm, one of the main feature of COVID19- disease (PMID: 33399072).

However, it is still unclear from authors data whether benefits of G-CSF administration outweigh its risks.

 

Major points:

• The study suffer from the limited number of patients analyzed. 
• The fact that patients are affected by different cancer forms and that they were treated with different pharmacological therapies complicate interpretation of author’s findings.
• Is Cancer diagnosis an independent risk factor for poor outcome?
• Could authors calculate p-values for each subcategory (Table I and II) ?

Minor Points:

• line 56 : Typo in SARS-COV2.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

The authors have adressed all the comments of the reviewer.

Reviewer 2 Report

In this revised version authors did not add any information to the previous version and hence limiting the extent of their conclusions.

Considering the broad interest of the topic, I think that publish the manuscript in the present form will be in any case useful for the overall scientific community.