title: Colony-stimulating factors for chemotherapy-induced febrile neutropenia: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  Current treatment for febrile neutropenia (FN) includes hospitalization for evaluation, empiric broad-spectrum antibiotics, and other supportive care. Clinical trials have reported conflicting results when studying whether the colony-stimulating factors (CSFs) improve outcomes in patients with FN. This Cochrane Collaboration review was undertaken to further evaluate the safety and efficacy of the CSFs in patients with FN.
  
  
  METHODS
  An exhaustive literature search was undertaken including major electronic databases (CANCERLIT, EMBASE, LILACS, MEDLINE, SCI, and the Cochrane Controlled Trials Register). All randomized controlled trials that compare CSFs plus antibiotics versus antibiotics alone for the treatment of established FN in adults and children were sought. A meta-analysis of the selected studies was performed.
  
  
  RESULTS
  More than 8,000 references were screened, with 13 studies meeting eligibility criteria for inclusion. The overall mortality was not influenced significantly by the use of CSF (odds ratio [OR] = 0.68; 95% CI, 0.43 to 1.08; P = .1). A marginally significant result was obtained for the use of CSF in reducing infection-related mortality (OR = 0.51; 95% CI, 0.26 to 1.00; P = .05). Patients treated with CSFs had a shorter length of hospitalization (hazard ratio [HR] = 0.63; 95% CI, 0.49 to 0.82; P = .0006) and a shorter time to neutrophil recovery (HR = 0.32; 95% CI, 0.23 to 0.46; P < .00001).
  
  
  CONCLUSIONS
  The use of the CSFs in patients with established FN caused by cancer chemotherapy reduces the amount of time spent in hospital and the neutrophil recovery period. The possible influence of the CSFs on infection-related mortality requires further investigation.
authors.affiliation: Hospital Celso Pierro/PUC-Campinas, Sao Paulo, Brazil.
authors.forename: Otavio A C
authors.initials: OA
authors.lastname: Clark
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
authors.forename: Aldemar A
authors.initials: AA
authors.lastname: Castro
authors.forename: Luciana G O
authors.initials: LG
authors.lastname: Clark
authors.forename: Benjamin
authors.initials: B
authors.lastname: Djulbegovic
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D003115:Colony-Stimulating Factors / Q000627:therapeutic use*; D005334:Fever / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000970:Antineoplastic Agents; D003115:Colony-Stimulating Factors