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Meta-Analysis of Randomized Controlled Trials of Prophylactic Granulocyte Colony-Stimulating Factor and Granulocyte-Macrophage Colony-Stimulating Factor After Autologous and Allogeneic Stem Cell Transplantation

Allison Dekker, Sean Bulley, Joseph Beyene, L. Lee Dupuis, John J. Doyle, Lillian Sung

From the Departments of Public Health Sciences, Health Policy Management and Evaluation, and Paediatrics, and Faculty of Pharmacy, University of Toronto; and the Department of Pharmacy, Division of Hematology/Oncology, and Program in Population Health Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada

Address reprint requests to Lillian Sung, MD, PhD, Division of Hematology/Oncology, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8; e-mail: Lillian.sung{at}sickkids.ca

Purpose: The primary objective of our meta-analysis was to determine whether prophylactic hematopoietic colony-stimulating factors (CSFs) after hematopoietic autologous and allogeneic stem-cell transplantation (SCT) reduced documented infections. Our secondary objectives were to determine whether prophylactic CSFs affected other outcomes including parenteral antibiotic therapy duration, infection-related mortality, graft-versus-host disease (GVHD), or treatment-related mortality.

Methods: We included studies if there was random assignment between CSFs and placebo/no therapy and CSFs were given after SCT and before recovery of neutrophils. From 3,778 reviewed study articles, 34 were included based on predefined inclusion criteria. All analyses were conducted using a random effects model.

Results: CSFs reduced the risk of documented infections (relative risk [RR] 0.87; 95% CI, 0.76 to 1.00; P = .05) and duration of parenteral antibiotics (weighted mean difference, –1.39 days, 95% CI, –2.56 to –0.22; P = .02) but did not reduce infection-related mortality (RR, 0.76; 95% CI, 0.41 to 1.44; P = .4). CSFs did not increase grade 2 to 4 acute GVHD (RR, 1.03; 95% CI, 0.81 to 1.31; P = .8) or treatment-related mortality (RR, 1.00; 95% CI, 0.78 to 1.29; P = .98).

Conclusion: CSFs were associated with a small reduction in the risk of documented infections but did not affect infection or treatment-related mortality.

Supported in part by a Career Development Award by the Canadian Child Health Clinician Scientist Program (L.S.), a Canadian Institutes of Health Research strategic training program.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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