Clinical application of colony-stimulating factors

Several CSF preparations have gained regulatory approval (Table 10.2). G-CSF and GM-CSF have proven useful in the treatment of neutropenia. All three CSF types are (or are likely to be) useful also in the treatment of infectious diseases, some forms of cancer and the management of bone marrow transplants, as they stimulate the differentiation/activation of white blood cell types most affected by such conditions. 

Neutropenia is a condition characterized by a decrease in blood neutrophil count below 1.5 X 109 cells per litre a normal blood count is (2.0-7.5) X 109 cells per litre. Its clinical symptoms include the occurrence of frequent and usually serious infections, often requiring hospitalization. Neutropenia may be caused by a number of factors (Table 10.6), at least some of which are responsive to CSF treatment. Particularly noteworthy is neutropenia triggered by administration of chemotherapeutic drugs to cancer patients. Chemotherapeutic agents (e.g. cyclophosphamide, doxorubicin and methotrexate), when administered at therapeutically effective doses, often induce the destruction of stem cells and/or compromise stem cell differentiation. 

Severe bacterial infection Severe sepsis Severe viral infection Aplastic anaemia3 Acute leukaemia 

Hodgkin s/non-Hodgkin s lymphoma Various drugs, especially anti-cancer drugs Autoimmune neutropenia 

Commonly reported side effects include bone and muscle pain. Serious (sometimes life threatening) but rare side effects have included splenic rupture and adult respiratory distress syndrome. Neupogen is manufactured and marketed by Amgen Inc. 

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Sylvester, R. K. (2002), Clinical applications of colony-stimulating factors A historical perspective, Am. J. Health-Syst. Pharm., 59, s6-sl2. 

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