Sung, L., Nathan, P.C., Lange, B., Beyene, J., & Buchanan, G.R. (2004). Prophylactic granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor decrease febrile neutropenia after chemotherapy in children with cancer: A meta-analysis of randomized controlled trials. Journal of Clinical Oncology, 22, 3350–3356.

The purpose of this study was to examine colony-stimulating factors (CSFs) given to children with cancer prophylactically after initiation of chemotherapy prior to the development of febrile neutropenia.

OVID MEDLINE (January 1966 to July 2003) and EMBASE (January 1980 to July 2003) databases were searched. The search was limited to randomized, controlled trials (RCTs) that included children 18 years and younger. References were hand searched for relevant literature, and conference proceedings from meetings of the American Society of Hematology, American Society of Clinical Oncology, Society Internationale Oncologie Pediatric, and the American Society of Pediatric Hematology/Oncology from January 2001 to January 2003 were reviewed. Manufacturers of G-CSF and GM-CSF were contacted.

16 RCTs. Five studies evaluated GM-CSF, and 11 examined G-CSF.

1,183 children, 592 of whom were randomized to CSF and 591 to the control arm.

In children with cancer:

• CSFs reduced the rate of febrile neutropenia by 20%.
• CSFs reduced hospitalization duration by two days.
• CSFs reduced the documented infection rate by 22%.
• CSFs reduced the duration of neutropenia by four days.
• CSFs reduced the rate of amphotericin use by 50%.
• CSFs were not associated with a reduction in infection-related mortality.
• CSFs were not associated with a difference in duration of parenteral antibiotics.
• CSFs were not associated with a difference in the duration of chemotherapy delay.

The rates of febrile neutropenia in all of the included studies were 39% or higher, so the researchers concluded that prophylactic CSFs should be used in children with cancer who are receiving chemotherapy with an anticipated rate of febrile neutropenia 40% or higher. No explicit measurement of quality of life exists, but researchers hypothesize that decreasing hospitalization and febrile neutropenia would contribute to improved quality of life.