Therapeutic use of colony stimulating factors for established neutropenic fever

The hematopoietic growth factors granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) are approved only for prophylaxis of infectious complications secondary to the use of chemotherapy, yet both are often used off-label therapeutically in conjunction with antibiotics following the onset of neutropenic fever. Several recent trials have evaluated the use of CSFs as adjuncts to antibiotic therapy for the management of patients presenting with neutropenic fever following chemotherapy administration. Statistically significant reductions in days of neutropenia by one or two days were observed in some trials but the clinical significance of these results is uncertain. Most trials demonstrated no reductions in duration of hospitalization, number of days of fever, or mortality. Given the current lack of data supporting the use of CSFs as adjuncts to antibiotic therapy in patients presenting with neutropenic fever, and given the high cost of these drugs, their use for this indication is not recommended at this time.