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Use of recombinant hematopoietic growth factors in bone marrow transplantation
1Division of Oncology, VA Medical Center, Seattle, Washington.
Purpose:
A number of glycoprotein hematopoietic growth regulatory molecules have been identified and molecularly cloned. Three have been approved for clinical use and several are in various stages of clinical trials. The purpose of this review is to describe clinically relevant aspects of the biology of hematopoietic growth factors, to analyze the clinical trials data on their use with emphasis on studies in marrow transplantation, and to project directions for further study of both the approved and the investigational agents.
Patients:
Individuals undergoing autologous or allogeneic bone marrow transplantation.
Design:
Phase I toxicity trials through randomized, placebo-controlled Phase III studies.
Results:
Appropriate use of hematopoietic growth factors can reduce transplant-associated morbidity, shorten initial hospitalizations, and reduce the cost of transplantation. Preliminary data suggest that cytokine-mobilized peripheral blood progenitor cells may be able to replace marrow as the sole source of stem cells for transplantation.
Conclusions:
Additional studies are needed to determine the optimal use of approved growth factors and to determine how best to use those that are still investigational agents. Comparative studies of marrow versus alternative sources of stem cells such as mobilized peripheral blood progenitor cells are also needed.