Meta-analysis of randomized controlled trials of prophylactic granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor after autologous and allogeneic stem cell transplantation.
OBJECTIVE
The primary objective of our meta-analysis was to determine whether prophylactic hematopoietic colony-stimulating factors (CSFs) after hematopoietic autologous and allogeneic stem-cell transplantation (SCT) reduced documented infections. Our secondary objectives were to determine whether prophylactic CSFs affected other outcomes including parenteral antibiotic therapy duration, infection-related mortality, graft-versus-host disease (GVHD), or treatment-related mortality.


METHODS
We included studies if there was random assignment between CSFs and placebo/no therapy and CSFs were given after SCT and before recovery of neutrophils. From 3,778 reviewed study articles, 34 were included based on predefined inclusion criteria. All analyses were conducted using a random effects model.


RESULTS
CSFs reduced the risk of documented infections (relative risk [RR] 0.87; 95% CI, 0.76 to 1.00; P = .05) and duration of parenteral antibiotics (weighted mean difference, -1.39 days, 95% CI, -2.56 to -0.22; P = .02) but did not reduce infection-related mortality (RR, 0.76; 95% CI, 0.41 to 1.44; P = .4). CSFs did not increase grade 2 to 4 acute GVHD (RR, 1.03; 95% CI, 0.81 to 1.31; P = .8) or treatment-related mortality (RR, 1.00; 95% CI, 0.78 to 1.29; P = .98).


CONCLUSIONS
CSFs were associated with a small reduction in the risk of documented infections but did not affect infection or treatment-related mortality.
Dekker
Allison
A
Department of Public Health Sciences, Health Policy Management and Evaluation, and Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
Bulley
Sean
S
Beyene
Joseph
J
Dupuis
L Lee
LL
Doyle
John J
JJ
Sung
Lillian
L
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001424:Bacterial Infections / Q000188:drug therapy / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005060:Europe; D006086:Graft vs Host Disease / Q000517:prevention & control; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics / Q000627:therapeutic use*; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay; D009503:Neutropenia / Q000150:complications / Q000209:etiology; D016017:Odds Ratio; D011322:Primary Prevention / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D033581:Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D006113:United Kingdom; D014481:United States
D000900:Anti-Bacterial Agents; D016179:Granulocyte Colony-Stimulating Factor; D016178:Granulocyte-Macrophage Colony-Stimulating Factor