Use of hematopoietic growth factors in the treatment of acute myelogenous leukemia.

Several randomized trials evaluating the effect of hematopoietic growth factors, especially granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF), in the treatment of patients with acute myeloid leukemia, recently have been completed. The results of these trials generally show a reduction in the duration of neutropenia with variable results as far as severe infections, antibiotic use, and duration of hospitalization are concerned. Combining the data from the studies and especially from those with higher patient numbers, complete remission rates, event-free survival, and overall survival do not appear to be affected by the use of either G-CSF or GM-CSF after induction and consolidation therapy. The use of G-CSF or GM-CSF either before or during induction chemotherapy in an attempt to increase the leukemic cell kill has not resulted in improved response rates or survival. Only a few case reports indicate that G-CSF and GM-CSF might induce terminal differentiation of leukemic blast cells. Recently started trials evaluating the effect of megakaryocyte growth and development factor on platelet recovery indicate that it might not be easy to show a clinical benefit, possibly because of the rather low threshold counts needed for the prevention of overt bleeding. It still remains unclear whether the use of hematopoietic growth factors in these patients is cost-effective.