Prophylactic use of granulocyte colony-stimulating factor after consolidation therapy with high-dose cytarabine for acute myeloid leukemia

Prophylactic use of granulocyte colony-stimulating factor after chemotherapy in acute myeloid leukemia patients has become part of the supportive care strategy in some institutions. Despite shortening the neutropenia period and lowering the hospitalization rate, randomized studies have not shown any improvement in the clinical outcomes with this intervention. In their single-institution retrospective study, Bradley et al. reported that granulocyte colony-stimulating factor administration following consolidation therapy with high-dose cytarabine is associated with decreased hospitalization rate and improved survival. This finding is not consistent with the prior knowledge from the randomized studies. Herein, we review some of the explanations for the findings and re-emphasize the limitations of nonrandomized studies in assessing acute myeloid leukemia outcomes, as appreciated by the authors.