Hematopoietic growth factors in the treatment of acute leukemia.

Granulocyte macrophage (GM)- and granulocyte colony-stimulating factors (G-CSF) are being used after chemotherapy for newly-diagnosed acute myelogenous leukemia (AML) in order to hasten neutrophil recovery, thereby decreasing morbidity and mortality. This review summarizes data pertinent to the accomplishment of these aims. The preponderance of evidence indicates that, while accelerating recovery, neither GM- nor G-CSF producibly decrease major morbidity or mortality, particularly in elderly patients. Although in several studies, patients have been pretreated with GM- or G-CSF to sensitive AML cells to subsequent chemotherapy, these studies have not demonstrated benefit. The review raises questions as to whether elderly patients entered on clinical traits are representative of AML in the elderly, suggests that in vitro and ex vivo studies are needed to identify whether patient might benefit from CSFs, and discusses new ways to use cytokines in AML, eg in patients in complete remission.