Impact of granulocyte colony-stimulating factor (CSF) and granulocyte-macrophage CSF in patients with malignant lymphoma: a systematic review.
The granulopoiesis-stimulating factors, granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF), are used to prevent neutropenia and febrile neutropenia in patients with malignant lymphoma. The question as to whether G-CSF/GM-CSF improves dose-intensity, tumour response and overall survival (OS) has not yet been answered. As the results from single studies are inconclusive, a systematic review was performed to determine the effectiveness of G-CSF/GM-CSF. Randomized controlled trials comparing prophylaxis with G-CSF/GM-CSF versus no prophylaxis in adult patients with malignant lymphoma undergoing conventional chemotherapy were included. Medical databases (Cochrane Library, Medline, Embase) and conference proceedings were searched. All authors were contacted to obtain missing data. We included 11 studies making a total of 1434 patients. Compared with no prophylaxis, G-CSF/GM-CSF significantly reduced the relative risk (RR) for neutropenia [RR 0.64 [95% confidence interval (CI) 0.55-0.75]] febrile neutropenia (RR 0.74 [95% CI 0.62-0.89]) and infection (RR 0.74 [95% CI 0.64-0.85]). G-CSF/GM-CSF did not decrease infection-related mortality (RR 2.07 [95% CI 0.81-5.34]), improve complete remission (CR) (RR 1.06 [95% CI 0.96-1.16]) or OS (HR 0.98 [95% CI 0.81-1.18]). In conclusion, G-CSF/GM-CSF given during conventional chemotherapy in malignant lymphoma patients reduced the RR of neutropenia, febrile neutropenia and infection. However, there is no evidence that G-CSF/GM-CSF improved CR and OS in this clinical setting.
Bohlius
Julia
J
Department of Internal Medicine I, University of Cologne, Germany. a.engert@uni-koeln.de
Reiser
Marcel
M
Schwarzer
Guido
G
Engert
Andreas
A
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000517:prevention & control; D018572:Disease-Free Survival; D005334:Fever / Q000517:prevention & control; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use*; D006689:Hodgkin Disease / Q000188:drug therapy*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D009503:Neutropenia / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D016179:Granulocyte Colony-Stimulating Factor; D016178:Granulocyte-Macrophage Colony-Stimulating Factor