title: Myeloid growth factors in acute myeloid leukemia: systematic review of randomized controlled trials.
abstract: Randomized controlled trials (RCT) investigating administration of colony-stimulating factors (CSF) during or after chemotherapy in acute myeloid leukemia (AML) patients have not been systematically reviewed. We performed a meta-analysis of all reported RCTs comparing prophylactic or concurrent use of CSFs in adult AML patients. Two reviewers extracted data independently. Summary estimates with 95% confidence intervals (CIs) were calculated using a fixed effects model. Fourteen RCTs (n = 4,069 patients) were identified investigating prophylactic CSF administration. Time to neutrophil recovery (>500/μl) was significantly reduced in the CSF group (-4.13 days; 95% CI, -4.23 to -4.04) as was the length of hospitalization (-2.06 days; 95% CI, -2.36 to -1.76). However, no significant reduction in infection-related mortality was observed in CSF-treated compared with control patients (odds ratio (OR) 0.94; 95% CI, 0.8 to 1.1). Prophylactic CSF administration did not impact complete remission (CR) rate or survival. Fourteen RCTs (n = 4,518 patients) were identified investigating administration of CSFs during chemotherapy. Summary estimates of CR, disease/event-free, or overall survival were not significantly different for CSF versus control patients. Prophylactic CSF administration reduces the time to neutrophil recovery and length of hospitalization, but has no impact on documented infections or outcome. Economic analyses of prophylactic CSF administration in AML patients are warranted.
authors.affiliation: Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, Germany. heuser.michael@mh-hannover.de
authors.forename: Michael
authors.initials: M
authors.lastname: Heuser
authors.forename: Antonia
authors.initials: A
authors.lastname: Zapf
authors.forename: Michael
authors.initials: M
authors.lastname: Morgan
authors.forename: Jürgen
authors.initials: J
authors.lastname: Krauter
authors.forename: Arnold
authors.initials: A
authors.lastname: Ganser
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control; D003115:Colony-Stimulating Factors / Q000008:administration & dosage*; D006801:Humans; D007902:Length of Stay; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D055502:Secondary Prevention; D015996:Survival Rate
chemical_list: D000900:Anti-Bacterial Agents; D003115:Colony-Stimulating Factors