title: Review of granulocyte colony-stimulating factors in the treatment of established febrile neutropenia.
abstract: OBJECTIVE
  To assess the value of granulocyte colony-stimulating factors (G-CSF) in promoting recovery from established episodes of febrile neutropenia (FN) after chemotherapy in cancer patients.
  
  
  METHODS
  The literature was searched using the MEDLINE, EMBASE, BIOSIS, and IPA databases. Reference lists from the retrieved papers and hand searches of relevant journals complemented the search. Eleven randomized controlled trials were selected for review.
  
  
  RESULTS
  G-CSF use in established FN appears to be limited to a small reduction in neutropenia duration, length of hospitalization, and duration of antibiotic use. Overall, there are no significant reductions in time to neutrophil recovery and fever resolution. The cost analyses performed do not show significant cost savings.
  
  
  CONCLUSIONS
  Granulocyte colony-stimulating factors (G-CSF) are biological agents typically used for prevention of febrile neutropenia (FN) or as adjunctive treatment with antibiotics of established FN. Most clinical guidelines discourage the general use of G-CSF for adjunctive treatment of ongoing neutropenic fever; however, its use in special situations, such as high-risk for infectious complications or adverse prognostic factors, is advised. G-CSF should be reserved for high-risk cancer patients, in accordance with the results of this review. This recommendation needs to be taken with caution in view of the disparities and methodological flaws found among trials. It is necessary to design further trials appropriately, well-powered and focused on high-risk patients. Moreover, it is necessary to perform an appropriate economic evaluation for this setting.
authors.affiliation: Health Intervention and Technology Assessment Program, 6th Building Department of Health, Ministry of Public Health Tiwanon Rd, Muang, Nonthaburi 11000, Thailand. romanperezvelasco@gmail.com
authors.forename: Román
authors.initials: R
authors.lastname: Pérez Velasco
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005334:Fever / Q000139:chemically induced / Q000188:drug therapy* / Q000191:economics; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy* / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor