Use of growth factors during induction therapy for acute myeloid leukemia

The use of colony-stimulating factors (CSFs) in acute myeloid leukemia (AML) remains controversial. Potential uses include shortening the period of neutropenia, inducing leukemic cells into the S-phase of the cell cycle, stem cell protection, inducing differentiation of leukemic cells, interrupting autocrine/paracrine loops, direct inhibition of leukemogenesis, and enhancing antimicrobial function. Data from the nine controlled studies of CSFs that have been reported between 1990 and 1995, with varying patient characteristics and other factors, indicate that growth factors have several uses in AML therapy. The published literature now suggests that the safety of CSFs is no longer a major clinical concern, and significant experience has been gained in reducing the period of neutropenia following induction therapy. Yeast-derived granulocyte-macrophage colony-stimulating factor and granulocyte colony-stimulating factor appear to be effective and probably have an important role in the management of older adult patients with AML and for those patients with a significant risk for therapy-related morbidity and mortality. The use of CSFs as priming agents remains experimental; results of further prospective placebo-controlled studies, with laboratory correlates, are awaited.