Lyman, G.H., Kuderer, N.M., & Djulbegovic, B. (2002). Prophylactic granulocyte colony-stimulating factor in patients receiving dose-intensive cancer chemotherapy: A meta-analysis. American Journal of Medicine, 112, 406–411.

The purpose of the study was to evaluate colony-stimulating factors (CSFs) administered prophylactically, before the onset of neutropenia or fever, compared with concurrent placebo or untreated controls not allowing any dose escalation.

MEDLINE, EMBASE, and Cochrane Library databases were searched, and hand searches of references from published reports were conducted.

Eight randomized, controlled trials (RCTs), including 1,144 patients receiving chemotherapy for solid tumors (n = 753) or malignant lymphomas (n = 391); studies of patients who were receiving high-dose therapy that required stem cell or bone marrow transplantation (BMT) support or who were being treated for acute or chronic leukemia were excluded.

The overall mean risk of febrile neutropenia was 51% among patients not receiving CSFs, and the overall mean risk of febrile neutropenia was 32% among patients receiving CSFs.

CSFs significantly reduced:

• Febrile neutropenia by 37%
• Documented infections by 6%
• Chemotherapy dose reduction or treatment delay by 20%.

CSFs increased the risk of:

• Bone pain by 15%.

CSFs did not improve infection-related mortality.

The authors concluded that CSFs are effective in reducing the risk of febrile neutropenia, documented infections, and chemotherapy dose reductions or delays, but they increase the risk of bone pain. CSFs had no impact on infection-related mortality.