Hematopoiesis. Clinical application of colony-stimulating factors

The deleterious effects of chemotherapy on normal hematopoietic tissues may produce severe or protracted deficiencies in red blood cells, neutrophils, or platelets, and result in life-threatening infection or bleeding. Hematopoietic growth factors have had a profound influence on the management of patients undergoing cancer chemotherapy. Three recombinant hematopoietic growth factors have been licensed for clinical use in the United States: erythropoietin, G-CSF, and GM-CSF. Erythropoietin reduces the transfusion requirements of chemotherapy-induced anemia, and G-CSF and GM-CSF prevent infections due to chemotherapy-induced neutropenia, shorten the duration of neutropenia following high-dose chemotherapy, and stem cell transplantation and mobilize stem cells for transplantation. This chapter reviews randomized placebo-controlled trials of the licensed colony-stimulating factors in management of patients with cancer and briefly examines new agents that stimulate megakaryocyte and platelet development.