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Effectiveness and safety of granulocyte colony-stimulating factor priming regimen for acute myeloid leukemia: A systematic review and meta-analysis of the Clinical Practice Guideline for the use of G-CSF 2022 from the Japan Society of Clinical Oncology

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Abstract

Background

The outcomes of relapsed or refractory acute myeloid leukemia (AML) remain poor. Although the concomitant use of granulocyte colony-stimulating factor (G-CSF) and anti-chemotherapeutic agents has been investigated to improve the antileukemic effect on AML, its usefulness remains controversial. This study aimed to investigate the effects of G-CSF priming as a remission induction therapy or salvage chemotherapy.

Methods

We performed a thorough literature search for studies related to the priming effect of G-CSF using PubMed, Ichushi-Web, and the Cochrane Library. A qualitative analysis of the pooled data was performed, and risk ratios (RRs) with confidence intervals (CIs) were calculated and summarized.

Results

Two reviewers independently extracted and accessed the 278 records identified during the initial screening, and 62 full-text articles were assessed for eligibility in second screening. Eleven studies were included in the qualitative analysis and 10 in the meta-analysis. A systematic review revealed that priming with G-CSF did not correlate with an improvement in response rate and overall survival (OS). The result of the meta-analysis revealed the tendency for lower relapse rate in the G-CSF priming groups without inter-study heterogeneity [RR, 0.91 (95% CI 0.82–1.01), p = 0.08; I2 = 4%, p = 0.35]. In specific populations, including patients with intermediate cytogenetic risk and those receiving high-dose cytarabine, the G-CSF priming regimen prolonged OS.

Conclusions

G-CSF priming in combination with intensive remission induction treatment is not universally effective in patients with AML. Further studies are required to identify the patient cohort for which G-CSF priming is recommended.

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Data availability

Data associated with this systematic review may be accessed from the corresponding author upon reasonable request.

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Acknowledgements

The authors are grateful to Ms. Natsuki Narita for her contribution to the initial literature search. The authors thank Ms. Natsuki Fukuda for her valuable comments and suggestions. We would like to thank Editage (www.editage.jp) for English language editing.

Funding

This study was partially supported by the Japan Society for the Promotion of Science, KAKENHI (grant number: JP22K15615).

Author information

Authors and Affiliations

  1. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-8-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan

    Yuho Najima

  2. Department of Hemato-Oncology, Saitama Medical University International Medical Center, Saitama, Japan

    Tomoya Maeda

  3. Department of Clinical Oncology/Hematology, The Jikei University School of Medicine, Tokyo, Japan

    Yutaro Kamiyama & Shingo Yano

  4. Department of Hematology, Faculty of Medicine, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan

    Shinji Nakao

  5. Department of Breast Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Yukinori Ozaki & Toshimi Takano

  6. Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan

    Hiroshi Nishio

  7. Department of Hematology, Oncology and Cardiovascular Medicine, Fukuoka, Japan

    Kenji Tsuchihashi & Mamoru Ito

  8. Center for Clinical Oncology, Okayama University Hospital, Okayama, Japan

    Eiki Ichihara

  9. Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan

    Yuji Miumra

  10. Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan

    Makoto Endo

  11. Department of Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Dai Maruyama

  12. Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan

    Tetsuhiro Yoshinami

  13. Department of Obstetrics and Gynecology, International University of Health and Welfare Narita Hospital, Chiba, Japan

    Nobuyuki Susumu

  14. Department of Gynecology, Shizuoka Cancer Center, Shizuoka, Japan

    Munetaka Takekuma

  15. Department of Obstetrics and Gynecology, Tokyo Women’s Medical University Hospital, Tokyo, Japan

    Takashi Motohashi

  16. Department of Oncology and Social Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Eishi Baba

  17. Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan

    Nobuaki Ochi

  18. Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan

    Toshio Kubo

  19. Department of Medical Oncology, NTT Medical Center Tokyo, Tokyo, Japan

    Keita Uchino

  20. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan

    Takahiro Kimura

  21. Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan

    Shinobu Tamura

  22. Department of Nursing, Okayama University Hospital, Okayama, Japan

    Hitomi Nishimoto

  23. Department of Drug Information, Faculty of Pharmaceutical Sciences, Shonan University of Medical Sciences, Kanagawa, Japan

    Yasuhisa Kato

  24. Department of Medical Oncology, Hirosaki University Graduate School of Medicine, Aomori, Japan

    Atsushi Sato

Authors
  1. Yuho Najima
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  2. Tomoya Maeda
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  3. Yutaro Kamiyama
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  4. Shinji Nakao
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  5. Yukinori Ozaki
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Contributions

All the authors contributed to the conception and design of this present study. Y.N. wrote the draft of the manuscript, and all authors reviewed and commented on the manuscript. All the authors have read and approved the manuscript.

Corresponding author

Correspondence to Yuho Najima.

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Conflict of interest

T. Maeda reports scholarship donation from Chugai Pharmaceutical. SN reports honoraria from Kyowa Kirin. YO reports honoraria from Daiichi Sankyo, Pfizer, Chugai Pharmaceutical, Eli Lilly and Company, and Kyowa Kirin. KT reports honoraria from Ono Pharmaceutical, Chugai Pharmaceutical, Taiho Pharmaceutical, and Novartis Pharma. EI reports honoraria from Eli Lilly and Company, research funding from MSD, Ono Pharmaceutical, Jannsen Pharma, and Takeda Pharmaceutical. YM reports honoraria from Ono Pharmaceutical, MSD, Takeda Pharmaceutical, Eisai, Bristol Myers Squibb, research funding from MSD, and Ono Pharmaceutical. DM reports honoraria from Ono Pharmaceutical, Janssen Pharma, Nippon Shinyaku, Eisai, Mundipharma, Kyowa Kirin, Chugai Pharmaceutical, Zenyaku, MSD, SymBio Pharmaceuticals, Sanofi, AbbVie, Takeda Pharmaceutical, AstraZeneca, Bristol Myers Squibb, Genmab, research funding from Amgen Astellas Biopharma, Novartis Pharma, Kyowa Kirin, Ono Pharmaceutical, Chugai Pharmaceutical, Janssen Pharma, Takeda Pharmaceutical, Otsuka Pharmaceutical, Sanofi, Astellas, Bristol Myers Squibb, AbbVie, Eisai, MSD, Taiho Pharmaceutical, AstraZeneca, Eli Lilly and Company, and Genmab. TY reports honoraria from Kyowa Kirin, Pfizer, Chugai Pharmaceutical, Eli Lilly and Company, MSD, AstraZeneca, and Eisai. T. Motohashi reports honoraria from AstraZeneca, Chugai Pharmaceutical, and Myriad Genetics. EB reports honoraria from Chugai Pharmaceutical, Daiichi Sankyo, research funding from Taiho Pharmaceutical, and Chugai Pharmaceutical. T. Kubo reports honoraria from Chugai Pharmaceutical. T. Kimura reports honoraria from Sanofi. AS reports honoraria and research funding from Chugai Pharmaceutical, and Taiho Pharmaceutical. TT reports honoraria from Daiichi Sankyo, Chugai Pharmaceutical, and Eli Lilly and Company. SY reports research funding from Otsuka Pharmaceutical. The other authors declare that there are no conflicts of interest associated with this manuscript.

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Najima, Y., Maeda, T., Kamiyama, Y. et al. Effectiveness and safety of granulocyte colony-stimulating factor priming regimen for acute myeloid leukemia: A systematic review and meta-analysis of the Clinical Practice Guideline for the use of G-CSF 2022 from the Japan Society of Clinical Oncology. Int J Clin Oncol (2024). https://doi.org/10.1007/s10147-023-02461-4

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