FUTURE USES OF GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR (GM-CSF)

Granulocyte-macrophage colony-stimulating factor (GM-CSF) has been use d extensively to restore hematopoietic system function after damage by diseases such as myelodysplastic syndrome or by cytotoxic anti-cancer agents used during cancer chemotherapy or prior to bone marrow transp lantation. The clinical benefits of this approach have included fewer infections, fewer hospital days and less antibiotic use. In the future , the use of GM-CSF will be focused on special situations within these general areas, plus new directions that were not previously given suf ficient attention. Examples of focused approaches include the use of G M-CSF in the control of fungal or protozoal disease and to take advant age of anti-tumor effects of myeloid cell activation. The anti-microbi al effects will also be explored in patients who are not neutropenic b ut have serious infections which may be benefited by increased stimula tion to myeloid cell function. The use will also be focused on mobiliz ation of peripheral blood progenitor cells and in cycling of normal he matopoietic and malignant cells. The new directions will include use o f GM-CSF by local application in healing of cutaneous ulcers, rapid wo und closure and skin grafting. Because of its potent effects on immuno logic mechanisms of antigen presentation, it will be used in several w ays as a vaccine adjuvant. This adjuvant action will be directed at en hancing immunologic responses to antimicrobial antigens and anti-tumor antigens. The future of GM-CSF as a tool for hematopoietic and immuno logic stimulation with resulting important clinical benefits is clear.