Jj. Rusthoven et al., CONSENSUS ON THE USE OF NEUTROPHIL-STIMULATING HEMATOPOIETIC GROWTH-FACTORS IN CLINICAL-PRACTICE - AN INTERNATIONAL VIEWPOINT, International journal of antimicrobial agents, 8(4), 1997, pp. 263-275
Hematopoietic growth factors (CSFs) are now available for use in patie
nts with myelosuppression due to congenital, acquired and therapy-indu
ced conditions. Variations in the use of granulocyte colony-stimulatin
g factor (G-CSF) and granulocyte-macrophage colony-stimulating factor
(GM-CSF) in different countries are due to differences in approved ind
ications by national regulatory agencies, varying opinions on the impo
rtance of certain treatment outcomes, differences in the selection of
published and unpublished evidence of efficacy and the impact of the c
ost of these agents in different health care systems. Through Medline
searches and personal files, we have reviewed the published literature
on the efficacy and cost of GM-CSF and G-CSF in patients with severe
chronic neutropenia and those receiving standard dose chemotherapy or
high-dose chemotherapy requiring bone marrow reconstitution. Guideline
s were established with regard to (1) the relative merits of different
types of clinical studies and (2) the relative importance of differen
t clinical outcomes as reported in these studies. The cost implication
s of these agents as they apply to the different clinical settings are
also reviewed. Recommendations for the use of G-CSF and/or GM-CSF inc
lude: (1) the prevention of recurrent, debilitating infections in pati
ents with severe chronic neutropenia; and (2) the maintaining of dose-
intensity of potentially curative, standard-dose chemotherapy. While G
-CSF and/or GM-CSF have been shown to improve secondary outcomes in hi
gher-than-standard dose-intensive therapy, further studies are needed
to test whether such improvements also lead to significant improvement
s in survival and/or quality of life. These recommendations are based
on the collective interpretation of the presented evidence by an inter
national group of investigators in this area. (C) 1997 Elsevier Scienc
e B.V.