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THE USE OF HEMATOPOIETIC GROWTH FACTORS IN CHILDREN WITH CANCER

Several hematopoietic growth factors (HGFs) have recently been molecularly cloned, and recombinant (r) human (h) products are available for clinical use. Three products have been approved for clinical use. Granulocyte-colony-stimulating factor (rhG-CSF, filgrastim [Neupogen]) and granulocyte-macrophage-colony-stimulating factor (rhGM-CSF, sargramostim [Leukine]) stimulate, respectively, the proliferation, maturation, and function of granulocytes, and that of granulocytes, macrophages, and possibly megakaryocytes. Erythropoietin (rhEPO, epoetin alfa [Epogen, Procrit]) stimulates the proliferation and differentiation of committed erythroid progenitors, including burst-forming unit-erythroid cells and colony-forming unit-erythroid cells.

Even though HGFs are approved for use in children, both the indication for the administration of HGFs and their doses for children are largely unsettled. Although the absolute neutrophil count (ANC) may fall as low with these HGFs as without them, the duration of neutropenia is typically shorter. The intensification of some chemothera-peutic regimens might not be feasible without the use of rhG-CSF or rhGM-CSF for the faster recovery of granulocytes and macrophages. Little information exists for the use of rhEPO in children. However, 68 there are unique situations in which the use of rhEPO is reasonable, such as for patients who will not accept blood transfusions for religious reasons.

These guidelines should be considered as a framework that will be refined with time. When no specific recommendation for the use of rhG-CSF, rhGM-CSF, or rhEPO is made in a study protocol or the patient is not in a study, the following guidelines will prove useful.

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Cancer

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