New clinical applications of granulocyte-macrophage colony-stimulating factor.

The cytokine granulocyte-macrophage colony stimulating factor (GM-CSF) has a pleiotropic activity that influences not only proliferation and differentiation of stem cells but also regulates several other cells involved in acute and chronic inflammation, as well as in the immune response. During the past 5 years, investigations have been performed to treat pathological situations rather than cytostatic induced neutropenia. This review presents the available experience on healing cut-, burn-wounds, leg ulcers, skin-graft resolution as well as cytostatic and radiotherapy induced mucositis by administration of GM-CSF. The next 5 years will probably be spent analysing the use of GM-CSF in the therapeutic dimension, considering the advantages that patients and clinicians can achieve. In particular, GM-CSF will have a greater role, when doses and mode of application are finally defined, in treating complicated cut-burn wounds and unsuccessful skin-grafted resolutions. The evidence reported by ongoing randomised clinical trials will benefit patients with severe chemotherapy and radiotherapy induced mucositis.