The findings of a meta-analysis corroborate previous reports that while intensified chemotherapy combined with primary granulocyte colony-stimulating factor (G-CSF) improves overall survival, it is also increases the risk of developing secondary malignancies, according to a report published in the Annals of Oncology.

G-CSF support ameliorates the risk of neutropenic complications in high-risk cancer patients and is commonly recommended by several clinical practice guidelines. G-CSF is thought to improve disease control and survival by minimizing treatment delays, as well as allow for the administration of higher doses of chemotherapy in shorter time intervals.

The authors of the meta-analysis screened 2604 articles and identified 14 eligible randomized controlled trials in which patients received either conventional dose chemotherapy or G-CSF support. The studies also included a control group without G-CSF and had a minimum follow-up period of 2 years. These 14 newly identified studies were combined with studies that were previously identified in another meta-analysis for a total of 68 studies with 71 different comparisons.

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Consistent with previous meta-analysis findings, survival was significantly improved in patients who received G-CSF support compared with patients who had no G-CSF support. However, patients with G-CSF support were also more likely to experience secondary malignancies, particularly, acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS).

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More studies are needed to determine if this increased risk for secondary malignancy is due to G-CSF support itself, or to the leukemogenic effects of intensified chemotherapeutic agents often used with G-CSF support. “However, the reduced overall mortality risk in patients receiving G-CSF-supported chemotherapy is reassuring,” concluded the authors. 


Lyman GH, Yau L, Nakov R, Krendyukov A. Overall survival and risk of second malignancies with cancer chemotherapy and G-CSF support. Ann Oncol. 2018;29(9):1903-1910.