Granulocyte Colony-Stimulating Factor in Children with Acute Lymphoblastic Leukemia

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Abstract
The conclusion of Pui et al. (June 19 issue)1 that “whether the benefits of G-CSF [granulocyte colony-stimulating factor] therapy justify its use in individual cases is ultimately a matter of clinical judgment” is surprising. Their study showed that G-CSF use halved the median duration of hospital stays (from 10 days to 6 days, P = 0.011) and the incidence of documented infections (from 27 to 12, P = 0.009). Children receiving G-CSF had fewer episodes of bacteremia, disseminated fungal infections, cellulitis, central venous catheter–associated infections, otitis media, Clostridium difficile enterocolitis, and lymphadenitis. Nevertheless, the editorial in the same issue2 also concludes that “since there was no clear-cut clinical benefit of treatment with G-CSF and the median total costs of supportive care were similar in the G-CSF and placebo groups, the results of the study have to be considered negative.”

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