Hematopoietic growth factors in the prevention of infections complicationsin children with hematologic-oncologic diseases.

The hematopoietic colony-stimulating factors have been introduced into clin ical practice as additional supportive measures that can reduce, but not el iminate infectious complications associated with therapy-induced neutropeni a. Over the past decade, we have begun to appreciate the subtler aspects of the proper use of G-CSF and GM-CSF, identifying appropriate indications an d contraindications. in the course of evaluating the multitude of studies, a set of formal recommendations have been propagated for the judicious use of these expensive growth factors [2,3,78,92]. To prevent serious infection , the use of G- or GM-CSF is recommended in a subset of pediatric cancer pa tients shortly after receiving chemotherapy or a marrow transplant. Childre n with intensive chemotherapy (e.g., children with high risk ALL, NHL or me tastatic neuroblastoma) seem to benefit from hematopoietic growth factors w hereas it is not clear that this applies to children undergoing therapy for solid tumors such as rhabdomyosarkoma or Ewing's sarcoma. An exciting deve lopment is the use of G-CSF and GM-CSF to mobilize peripheral-blood progeni tor cells. Future studies in pediatric cancer patients are clearly warrante d to address several issues. Prospective clinical trials are still needed t o define specific treatment groups who can benefit from growth factor suppo rt. In this regard, efforts must be directed at better defining the endpoin ts and in particular, assigning value to reduction in treatment of possible infectious complications, such as days in hospital, antibiotic usage and c osts. In addition, randomized studies are required to evaluate the proper d osage and duration of therapy, which most likely will vary between groups, depending upon underlying malignancy and therapy given. in addition, combin ations of different growth factors have to be tested, particularly if ex vi vo expansion and the storage of hematopoietic stem cells are to be utilized in a wider spectrum of patients.