Myeloid growth factors

Neutropenia and resulting febrile neutropenia (FN) can be induced by myelosuppressive chemotherapy. FN is a major dose-limiting toxicity of chemotherapy, often requiring hospitalization to evaluate and treat. Further, these complications often result in dose reductions or treatment delays, which may compromise clinical outcomes. Although the prophylactic use of colony-stimulating factors (CSFs) can reduce the risk, severity, and duration of FN, they are not administered to all patients undergoing myelosuppressive chemotherapy because of the associated costs. Selective use, however, may enhance cost-effectiveness by directing treatment toward patients most likely to benefit. Filgrastim and pegfilgrastim, both granulocyte colony-stimulating factors (G-CSF), have FDA approval for use in the prevention of chemotherapy-induced neutropenia. In contrast, the labeled indication for sargramostim, a granulocyte-macrophage colony-stimulating factor (GM-CSF), is limited to use after induction therapy for acute myeloid leukemia and in various stem cell transplantation settings. These guidelines focus on the use of CSFs in the cancer setting; specifically addressing adult patients with solid tumors and nonmyeloid malignancies.