Therapeutic use of granulocyte and granulocyte-macrophage colony-stimulating factors in febrile neutropenic cancer patients

Abstract

The effectiveness of granulocyte and granulocyte-macrophage colony-stimulating factor (G-CSF and GM-CSF) in the treatment of febrile neutropenic cancer patients remains controversial. To assess their role in this condition, we conducted a systematic review of randomised trials published as full papers. A methodological evaluation using a specifically designed quality scale was performed before meta-analysis. Eleven trials were eligible, 8 of which were meta-analysable. The median quality score for the 11 pooled trials was 58.3% (range: 33.3%-68.8%). No significant quality difference was observed between positive (colony-stimulating factor more effective) and negative trials ( P=0.36). No quality difference was observed between the 8 meta-analysable studies and the 3 others, with respective median scores of 59.3% and 50%. No advantage was detected for the use of CSF in terms of mortality from febrile neutropenia, with a relative risk of 0.71 (95% CI 0.44-1.15). The relative risk was 0.66 (95% CI 0.39-1.13) in the G-CSF subgroup and 0.97 (95% CI 0.34-2.79) in the GM-CSF subgroup. Aggregation of the results on infection-related mortality, length of stay in hospital, fever and of neutropenia duration, antibiotic therapy adaptation and duration, superinfection rate and toxicity was not possible owing to the lack of adequate data in the publications. On the basis of this review, we cannot recommend the routine use of G-CSF or GM-CSF in established febrile neutropenia.

Outcome of Febrile Neutropenic Patients on Granulocyte Colony Stimulating Factor in a Tertiary Care Hospital

“…The gender distribution was equal in the study group, but mortality had a slight male predominance. The overall mortality was 13.7% which is comparable from international studies (Berghmans et al, 2002) Use of GCSF did improve the outcome in older patients and assumed to decrease the mean duration of hospital stay. However, it remained debatable whether this was a cost effective strategy or not especially when 34% of our study patients received chemotherapy for metastatic disease.…”

Side effects of therapy of hepatitis C and their management

“…7,8 Cytokines, such as granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor, have been shown to significantly increase white blood cells and neutrophils in congenital neutropenia, idiopathic neutropenia, leukemic neutropenia, and aplastic anemia. 32,33 It is conceivable that these agents could be used to support neutrophil counts during antiviral therapy. However, data remain extremely limited.…”

“…Nevertheless, even among febrile neutropenic patients with cancer, a recent meta-analysis suggests marginal benefit for the therapeutic use of cytokine growth factors. 33 Thus, a more liberal definition of neutropenia for the patient with hepatitis C on therapy might permit dose reductions at lower neutrophil counts than currently recommended without compromising safety. This may have particular implications for some black patients, whose constitutional neutropenia may exclude them from therapy or may necessitate early dose reductions based on current guidelines.…”

A prospective randomised evaluation of G-CSF or G-CSF plus oral antibiotics in chemotherapy-treated patients at high risk of developing febrile neutropenia

“…In a meta-analysis, G-CSF did not affect mortality but significantly reduced the incidence of neutropenic fever (odds ratio=0.29, 95%CI=0.21-0.40) at an average cost associated with the prevention of an episode of neutropenic fever of US$14,372 [16,2].…”