Recommendations on the use of colony-stimulating factors on children: conclusions of a European panel

During 1996 and 1997 a panel of European haematologists, oncologists, and n eonatologists developed specific paediatric guidelines for the use of colon y stimulating factors based on published literature and the clinical experi ence of these specialists within each of 13 countries. Well established ind ications for use comprise intervention in patients with life-threatening in fection, adjunctive therapy post autologous bone marrow transplantation (BM T), mobilization of peripheral blood progenitor cells for autologous BMT, p atients with acquired aplastic anaemia on anti-lymphocyte globulin and cycl osporin regimen, and severe congenital neutropenia. Less clear indications include primary prophylaxis to support dose intensification in children wit h high risk/advanced malignancies, secondary prophylaxis to prevent neutrop enia in patients with a history of severe neutropenia, support therapy in c ases of poor marrow function following BMT and for deteriorating marrow fun ction following successful BMT, in neonatal sepsis and non infectious neona tal neutropenia, in drug induced neutropenia and in HIV-positive patients. Treatment is generally well tolerated and granulocyte colony stimulating fa ctor appears better tolerated than granulocyte and macrophage colony stimul ating factor. Economically colony stimulating factors have not been shown t o induce excessive costs for a given patient. Conclusion In general the adult guidelines are applicable to children but a dditional considerations (aggressive or very progressive childhood neoplasm s, specific indications, neonatal use, congenital disorders) must be taken into account.