The present and future of hematopoietic cytokines in clinical practice.

Hematologic toxicities can be a major problem in the delivery of some chemotherapy regimens. The way clinicians manage myelosuppression has evolved from a symptomatic approach to the use of cytokines to ameliorate or prevent anemia and neutropenia. Soon, new cytokines will be commercially available to manage thrombocytopenia. Cytokines are transforming oncology by permitting dose intensification through delivery of chemotherapy at the full dose and on time, as well as permitting high-dose chemotherapy. Clinical trials are also exploring the benefits of cytokines for myeloablative chemotherapy with cellular support (bone marrow transplantation or peripheral blood progenitor cell transplantation). Future applications of cytokines include ex vivo expansion and gene transfer therapy. For cancer patients, the ability to receive intensive doses of chemotherapy might mean improved survival rates.