The use of granulocyte colony-stimulating factor (G-CSF) to treat neutropenia in pediatric patients with acute myeloid leukemia (AML) may be associated with increased risk for relapse, according to research published in Pediatric Blood and Cancer.

In this multicenter, population-based study of 367 pediatric patients being treated for newly diagnosed AML, 35% of patients received G-CSF during the study period spanning 2004 to 2013. Patients came from multiple European nations and Hong Kong, China. Patients were treated for AML according to either the NOPHO-AML 2004 or DB AML-01 protocol. Some antimicrobial prophylaxis therapies were included; prophylactic G-CSF was typically reserved for neutropenic or life-threatening infectious episodes.

Usage of G-CSF decreased over the study period at an odds ratio of 0.8 per diagnostic year (95% CI, 0.7-0.9) after being adjusted for country.

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G-CSF was indicated for infections in 44% of total uses, for neutropenia in 32%, and prophylactically in 13%, with the indication missing for 11% of cases. The most common G-CSF drug used was filgrastim (82% of courses), followed by pegfilgrastim (9% of courses) and lenograstim (4% of courses), with information missing for 12% of courses.

Relapse risk was higher in patients treated with G-CSF compared with patients treated without G-CSF (adjusted hazard ratio [HR], 1.5; 95% CI, 1.1-2.2; P =.03). The 5-year cumulative incidence of relapse was 51% (95% CI, 41%-60%) in patients with G-CSF compared with 39% (95% CI, 32%-45%) in patients treated without G-CSF.

The median cumulative dosage of G-CSF was 75 mg/kg (range, 7-1460), but cumulative dosage beyond 75 mg/kg to 100 mg/kg did not appear to exacerbate relapse risk.

“Our results indicate that children that received G-CSF as supportive care were at an increased risk of relapse and support the concern that G-CSF use might be harmful in pediatric AML,” concluded the authors.


  1. Løhmann DJA, Asdahl PH, Abrahamsson J, et al. Use of granulocyte colony-stimulating factor and risk of relapse in pediatric patients treated for acute myeloid leukemia according to NOPHO-AML 2004 and DB AML-01 [published online March 7, 2019]. Pediatr Blood Cancer. doi: 10.1002/pbc.27701

This article originally appeared on Hematology Advisor