Clinical practice and future needs in recombinant human granulocyte colony-stimulating factor treatment: a review of randomized trials in clinical haemato-oncology

Recombinant human granulocyte colony-stimulating factor (rHuG-CSF) may have a significant impact on preventing infections associated with chemotherapy -induced neutropenia, as well as shortening time to tree lineage engraftmen t following high-dose chemotherapy and progenitor transplantation. However, the scientific literature documenting evidence-based practice is insuffici ent and often misinterpreted. This review presents data and discusses the e vidence for actual clinical practice in the use of rHuG-CSF in conventional cyclic chemotherapy, either prophylactic or therapeutic, and high-dose the rapy, either in priming for mobilization or post-transplantation. In the pa st decade, many reports have based their conclusions on surrogate markers, and it is time to move towards evaluation of clinically relevant factors. D ata must be generated prospectively based on current clinical practice, and several issues must be considered and evaluated to define the true clinica l benefit of rHuG-CSF with or without stem-cell support. Evaluation should include complications and needs for resources as well as impact on toxicity and efficacy of conventional or high-dose chemotherapy.