Clinical use of hematopoietic growth factors in urological malignancies

The identification of hematopoietic growth factors and their production using recombinant techniques have led to clinical evaluation of their effectiveness in treating primary bone marrow failure states and the myelosuppression caused by chemo- and radiotherapy. Granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage colony-stimulating factor (GMCSF), erythropoietin and, in phase I/II trials, thrombopoietin (TPO) and interleultin-11 (IL-11) are currently available for clinical use. Clinical studies performed with G-CSF and GM-CSF have proven their beneficial effects in accelerating hematopoietic recovery after chemotherapy. This results from a marked reduction in the risk of infections and a shortening of drug and radiation induced myelosuppression. CSFs are most important in mobilizing peripheral blood progenitor cells (PBPC) and have allowed high-dose therapy combined with stem cell support in urological malignancies, e.g., refractory germ cell tumors. In addition, CSFs play an important part in the modulation of responses of circulating or tissue phagocytes to bacterial or fungal microorganisms. This important role has only recently begun to be eluciated. However, evidence based, clinical practice guidelines for the use of hematopoietic growth factors in urological malignancies, as well as for fever and infection following cytostatic chemotherapy, have yet to be developed.