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Recommendations on the use of colony-stimulating factors in children: conclusions of a European panel
G Schaison1, O B Eden, G Henze
1Hospital Saint-Louis, Paris, France.
Insights
European experts developed pediatric guidelines for colony-stimulating factors, outlining established and potential uses in children, including infections and bone marrow transplantation. These treatments are generally safe and cost-effective.
Area of Science:
- Hematology
- Pediatric Oncology
- Neonatology
Background:
- Colony-stimulating factors (CSFs) are crucial in managing various hematological conditions.
- Existing guidelines primarily focus on adult populations, necessitating pediatric-specific recommendations.
Purpose of the Study:
- To establish evidence-based pediatric guidelines for CSF use.
- To consolidate clinical experience from European specialists across 13 countries.
Main Methods:
- A panel of European hematologists, oncologists, and neonatologists convened.
- Guidelines were developed based on published literature and expert clinical experience.
Main Results:
- Established indications include life-threatening infections, post-bone marrow transplantation (BMT) support, progenitor cell mobilization, aplastic anemia, and severe congenital neutropenia.
- Less established indications involve prophylaxis in high-risk malignancies, neutropenia history, neonatal conditions, and HIV-positive patients.
- Granulocyte CSF (G-CSF) is generally better tolerated than granulocyte-macrophage CSF (GM-CSF); treatments are cost-effective.
Conclusions:
- Adult CSF guidelines are largely applicable to children.
- Specific pediatric considerations include aggressive neoplasms, neonatal use, congenital disorders, and unique indications.
Unlabelled:
During 1996 and 1997 a panel of European haematologists, oncologists, and neonatologists developed specific paediatric guidelines for the use of colony stimulating factors based on published literature and the clinical experience of these specialists within each of 13 countries. Well established indications for use comprise intervention in patients with life-threatening infection, adjunctive therapy post autologous bone marrow transplantation (BMT), mobilization of peripheral blood progenitor cells for autologous BMT, patients with acquired aplastic anaemia on anti-lymphocyte globulin and cyclosporin regimen, and severe congenital neutropenia. Less clear indications include primary prophylaxis to support dose intensification in children with high risk/advanced malignancies, secondary prophylaxis to prevent neutropenia in patients with a history of severe neutropenia, support therapy in cases of poor marrow function following BMT and for deteriorating marrow function following successful BMT, in neonatal sepsis and non infectious neonatal neutropenia, in drug induced neutropenia and in HIV-positive patients. Treatment is generally well tolerated and granulocyte colony stimulating factor appears better tolerated than granulocyte and macrophage colony stimulating factor. Economically colony stimulating factors have not been shown to induce excessive costs for a given patient.
Conclusion:
In general the adult guidelines are applicable to children but additional considerations (aggressive or very progressive childhood neoplasms, specific indications, neonatal use, congenital disorders) must be taken into account.