Sung, L., Nathan, P.C., Alibhai, S.M.H., Tomlinson, G.A., & Beyene, J. (2007). Meta-analysis: Effect of prophylactic hematopoietic colony-stimulating factors on mortality and outcomes of infection. Annals of Internal Medicine, 147(6), 400–411.
To evaluate prophylactic colony-stimulating factors (CSFs) given concurrently with or after initiation of chemotherapy prior to the development of neutropenia compared with placebo or no therapy in patients with cancer undergoing chemotherapy or hematopoietic stem cell transplantation (HSCT)
The standard Quality of Reporting of Meta-Analyses (QUOROM) guidelines were used to guide the search.
DATABASES USED: Electronic searches of Ovid MEDLINE from 1966–April 24, 2007; EMBASE from 1980–April 26, 2007; and the Cochrane Central Register of Controlled Trials Register (CENTRAL) through the second quarter of 2006 were performed. The pharmaceutical manufacturers of granulocyte CSFs (G-CSFs) and granulocyte macrophage CSFs (GM-CSFs) also were contacted.
INCLUSION CRITERIA: Patients randomly were assigned to CSFs or to placebo or no therapy. CSFs were given concurrently with or after initiation of chemotherapy or conditioning for stem cell transplantation but before neutropenia developed. Chemotherapy or conditioning regimens or other supportive care was not planned to systematically differ between study groups.
FINAL NUMBER STUDIES INCLUDED = 148 RCTs
TOTAL PATIENTS INCLUDED IN THE REVIEW: 16,839 participants or cycles; 8,474 randomly were assigned to CSF and 8,365 to placebo or no treatment.
KEY SAMPLE CHARACTERISTICS: The RCTs included adult or pediatric patients with cancer undergoing chemotherapy or HSCT. The results were analyzed at the study level, not at the patient level.
Compared with the control, prophylactic CSFs did not significantly affect
Compared with the control, prophylactic CSFs significantly reduced
The median rate of febrile neutropenia in the placebo groups was 44.2% versus 25.3% in the CSF groups.
The use of G-CSFs had a greater effect than the use of GM-CSFs on reducing documented infections and febrile neutropenia, but all-cause mortality and infection-related mortality did not differ.