Use of haemopoietic growth factors: commentary on the ASCO/ECOG guidelines

In the past two to three years, a number of clinical guidelines have been issued that have attempted to recommend specific indications for the use of haemopoietic colony-stimulating factors,1,2 some of which have recently been updated.3 These guidelines are, for the most part, a welcome initiative to guide clinicians as to the most appropriate use of these powerful and expensive drugs. Here, we have attempted to offer a perspective on these guidelines based upon both a review of the literature and our own clinical experience, concentrating primarily on their use following conventional and high-dose therapy and for the purpose of peripheral blood stem cell mobilization. For the latter, it is worth remembering that a product licence for this indication was only obtained in Europe in 1995 and that this only covers autologous mobilization and not the mobilization of normal donors. Both the American Society of Clinical Oncology and the Eastern Co-operative Oncology Group guidelines rightly confine their comments to best clinical practice. However, certainly in the United Kingdom and probably elsewhere, it is impossible to divorce this entirely from the economic realities involved in the widespread use of colony-stimulating factors, hence the increasing number of research papers in which the authors emphasize not only the clinical but also the financial implications of their findings. Here, we have taken note of both clinical and economic considerations in framing our comments.