Growth factors in allogeneic transplantation

Several variables contribute to the successful outcome of allogeneic bone marrow transplantation. During the first 4 weeks after reinfusion of allogeneic marrow, morbidity and mortality rates related to pancytopenia are high. After this time the development of graft-versus-host disease and/or recurrence of malignancy may further increase morbidity and limit survival. Hematopoietic growth factors such as recombinant human granulocyte-macrophage and recombinant human granulocyte colony-stimulating factors reduce morbidity of patients receiving high-intensity chemotherapy regimens by stimulating earlier neutrophil recovery. Studies in allogeneic bone marrow transplantation patients who receive recombinant human granulocyte-macrophage, recombinant human granulocyte, and recombinant human macrophage colony-stimulating factors suggest that these factors are well tolerated. The severity of graft-versus-host disease is not adversely affected, morbidity is less, and survival may be improved in certain patient populations. Results of phase I and II trials with hematopoietic growth factors in patients undergoing allogeneic bone marrow transplantation will be reviewed.