Conclusions

Granulocyte growth factors can be given safely both as primary and secondary prophylaxis to the majority of patients with hematologic malignancies.

G-CSF administration in acute myeloid and lym-phoid leukemias, chronic lymphocytic leukemia, myelodysplasia, lymphomas, and in the postperipheral blood progenitor phase in all of these disease categories, and in myeloma, has lead to shortened duration of myelosuppression and subsequent decrease in morbidity due to reduction in the incidence of febrile neutropenias and other infectious complications. Survival, however, has not been reliably affected.

G-CSF is also indicated and should be prescribed in the specific situation when dose-dense/intense therapy is of potential benefit to the patient; e.g., when treating older lymphoma patients on a biweekly schedule with CHOP. While the optimal timing, dose, and duration are still not well established in most clinical situations, administration of 5 ^g/kg of G-CSF and, if chosen, 250 ^g/kg of GM-CSF are recommended, starting within 1-5 days after completion of therapy.10 Pegylated G-CSF has been found to be equally efficacious and safe as G-CSF in the setting of treating lymphomas with a standard regimen. However, further evaluation of pegfilgrastim is required to confirm safety and efficacy during induction and dose/dense consolidation therapy for leukemias, and in combination with dose/dense treatment regimens. Further evaluation is also needed in the pre- and posttransplantation settings.

Administration of erythropoietin is justified in early phases of myelodysplasias and during repetitive administration of chemotherapy cycles for patients with lymphomas in order to increase hemoglobin values, avoid transfusions, and ameliorate anemia-associated fatigue and improve quality of life. The optimal dose and frequency are still unknown, but the effects of erythropoietin prescribed to lymphoma patients at doses of 10,000 U thrice a week were equivalent to a dose of 30,000 U, given every 3 weeks, in one randomized trial. Darbepoetin alpha had been tested in patients with lymphoproliferative diseases and was found to be effective at ranges 1-4.5 g/kg per week in comparison to placebo. Patients with multiple myeloma, chronic lymphocytic leukemia, and lymphomas may benefit from administration of erythropoietin when they are experiencing symptoms related to low hemoglobin, and/or are transfusion dependent. Further studies are required to establish the role of erythropoietin and darbepoetin alpha in acute leukemias and, while preliminary data are encouraging, additional trials are needed in the peri- and posttransplantation settings.

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