Clinical use of hematopoietic growth factors in urological malignancies

The identification of hematopoietic growth factors and their production usi ng recombinant techniques have led to clinical evaluation of their effectiv eness in treating primary bone marrow failure states and the myelosuppressi on caused by chemo- and radiotherapy. Granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage colony-stimulating factor (GMCSF), erythro poietin and, in phase I/II trials, thrombopoietin (TPO) and interleultin-11 (IL-11) are currently available for clinical use. Clinical studies perform ed with G-CSF and GM-CSF have proven their beneficial effects in accelerati ng hematopoietic recovery after chemotherapy. This results from a marked re duction in the risk of infections and a shortening of drug and radiation in duced myelosuppression. CSFs are most important in mobilizing peripheral bl ood progenitor cells (PBPC) and have allowed high-dose therapy combined wit h stem cell support in urological malignancies, e.g., refractory germ cell tumors. In addition, CSFs play an important part in the modulation of respo nses of circulating or tissue phagocytes to bacterial or fungal microorgani sms. This important role has only recently begun to be eluciated. However, evidence based, clinical practice guidelines for the use of hematopoietic g rowth factors in urological malignancies, as well as for fever and infectio n following cytostatic chemotherapy, have yet to be developed.