The use of colony-stimulating factors as bone marrow support for systemic anticancer chemotherapy

Colony-stimulating factors (CSFs) are proteins that play normal roles in human hematopoietic physiology. Many of these factors have been cloned and sequences. This has led to recombinant DNA technology that now allows for production of large quantities of pharmacologically pure compounds. Granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) are two such compounds that have been approved by the US Food and Drug Administration for human use in specific medical circumstances. This article summarizes the experience of one institution in using these two CSFs and adds brief commentary on four other CSFs that are expected to come to general use in the near future--interleukin-1, interleukin-3, interleukin-6, and erythropoietin. Both G-CSF and GM-CSF are effective in protecting patients from the leukotoxic effects of cancer chemotherapy, but GM-CSF appears to have a comparatively narrow "dosing window," wherein the agent is effective and tolerable. Future studies should address combining these agents with platelet protective compounds to improve patient safety.