Benefits of GM-CSF Versus Placebo or G-CSF in Reducing Chemotherapy-Induced Complications: A Systematic Review of the Literature.

Unlike granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage colony-stimulating factor (GM-CSF) is not approved for reducing the incidence or duration of chemotherapy-induced febrile neutropenia. However, some studies have been conducted in this setting. A systematic review assessing the efficacy of GM-CSF versus placebo or G-CSF in reducing chemotherapy-induced febrile neutropenia and related complications was performed. Medline was reviewed for articles published between January 1987 and March 2003 that contained specific search terms. Explicit inclusion/exclusion criteria were developed for titles, abstracts, and articles. Two researchers reviewed (kappa>/= 0.7) and divided studies according to their evaluation of GM-CSF versus placebo or versus G-CSF. Nine studies were accepted: 6 randomized controlled trials compared GM-CSF versus placebo and 3 studies compared GM-CSF versus GCSF. Three placebo-controlled trials showed that GM-CSF was ineffective in reducing the risk of chemotherapy-induced febrile neutropenia. The remaining 3 trials reported incidence of fever and not febrile neutropenia: 2 reported a significantly increased incidence of fever in the GM-CSF group, and 1 reported that more patients receiving placebo experienced fever compared with patients in the GMCSF group (P > 0.05). The 3 studies comparing GM-CSF versus G-CSF reported fever as a primary outcome also. All 3 reported higher incidence of fever in the GM-CSF group (P < 0.05). Head-to-head trials of G-CSF and GM-CSF in reducing chemotherapy-induced complications are lacking. Identified GM-CSF studies did not show significant reduction in febrile neutropenia and fever.

Duke Scholars

Author Gary Herbert Lyman Medicine, Medical Oncology