Colony-stimulating factors for prevention of febrile neutropenia in children with acute lymphoblastic leukaemia

Prophylactic administration of colony-stimulating factors may reduce hospital stay and risk of infections, but there is no evidence of shortened duration of neutropenia nor fewer treatment delays in children with acute lymphoblastic leukaemia. There is no information on any possible effect on relapse or survival.

A Cochrane review included 6 studies with a total of 333 subjects. The use of colony-stimulating factor (CSF) significantly reduced the number of febrile neutropenia episodes (RR 0.63, 95% CI 0.46 to 0.85, with substantial heterogeneity; 2 studies), the length of hospitalisation (WMD -1.58, 95% CI -3.00 to -0.15; 3 studies), and number of infectious disease episodes (RR 0.56, 95% CI 0.39 to 0.80; 5 studies). Despite these results, CSF did not influence the length of episodes of neutropenia (WMD -1.11, 95% CI -3.55 to 1.32; 2 studies) or delays in chemotherapy courses (RR 0.75, 95% CI 0.47 to 1.20; 4 studies). Follow up was too short to provide useful information on any possible effect on relapse or survival.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and by inconsistency (heterogeneity in interventions and outcomes).

Ədəbiyyat

1. Sasse EC, Sasse AD, Brandalise S, Clark OA, Richards S. Colony stimulating factors for prevention of myelosupressive therapy induced febrile neutropenia in children with acute lymphoblastic leukaemia. Cochrane Database Syst Rev 2005;(3):CD004139 [Last assessed as up-to-date: 11 October 2008].