The use of colony-stimulating factors in the supportive care of patients with acute myelogenous leukemia (AML)

Acute myelogenous leukemia (AML) is an aggressive, rare type of blood cancer manifested by infections, bleeding and a high rate of mortality. It requires immediate treatment with intensive chemotherapy and sometimes also with bone marrow transplantation. Infections are a major cause of mortality in AML patients since intensive chemotherapy lowers the white blood cell (WBC) count and disrupts the immune system. Colony-stimulating factors (CSFs) are agents administered in order to increase the WBC count, in the hope that this will decrease the rate of infections. However, it has not been established whether their administration might adversely affect other outcomes related to the disease, such as the achievement of remission or the relapse rate. Most importantly, it is unknown whether their administration affects the survival of AML patients. Therefore, we conducted a systematic review assessing the influence of CSFs on disease and infection-related outcomes. Our review showed that the addition of CSFs to chemotherapy in AML patients affected neither overall survival, nor the achievement of disease remission or the rate of relapse. Importantly, they did not affect the rate of infections in this population. We concluded that CSFs post-chemotherapy should not be given routinely in AML patients. However, their administration could be considered on an individual basis.