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

Yuho Najima; Tomoya Maeda; Yutaro Kamiyama; Shinji Nakao; Yukinori Ozaki; Hiroshi Nishio; Kenji Tsuchihashi; Eiki Ichihara; Yuji Miumra; Makoto Endo; Dai Maruyama; Tetsuhiro Yoshinami; Nobuyuki Susumu; Munetaka Takekuma; Takashi Motohashi; Mamoru Ito; Eishi Baba; Nobuaki Ochi; Toshio Kubo; Keita Uchino; Takahiro Kimura; Shinobu Tamura; Hitomi Nishimoto; Yasuhisa Kato; Atsushi Sato; Toshimi Takano; Shingo Yano

doi:10.1007/s10147-023-02461-4

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 May 17. doi: 10.1007/s10147-023-02461-4. Online ahead of print.

Authors

Yuho Najima¹, Tomoya Maeda², Yutaro Kamiyama³, Shinji Nakao⁴, Yukinori Ozaki⁵, Hiroshi Nishio⁶, Kenji Tsuchihashi⁷, Eiki Ichihara⁸, Yuji Miumra⁹, Makoto Endo¹⁰, Dai Maruyama¹¹, Tetsuhiro Yoshinami¹², Nobuyuki Susumu¹³, Munetaka Takekuma¹⁴, Takashi Motohashi¹⁵, Mamoru Ito⁷, Eishi Baba¹⁶, Nobuaki Ochi¹⁷, Toshio Kubo¹⁸, Keita Uchino¹⁹, Takahiro Kimura²⁰, Shinobu Tamura²¹, Hitomi Nishimoto²², Yasuhisa Kato²³, Atsushi Sato²⁴, Toshimi Takano⁵, Shingo Yano³

Affiliations

¹ Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-8-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan. yuhonajima@gmail.com.
² Department of Hemato-Oncology, Saitama Medical University International Medical Center, Saitama, Japan.
³ Department of Clinical Oncology/Hematology, The Jikei University School of Medicine, Tokyo, Japan.
⁴ Department of Hematology, Faculty of Medicine, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan.
⁵ Department of Breast Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
⁶ Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan.
⁷ Department of Hematology, Oncology and Cardiovascular Medicine, Fukuoka, Japan.
⁸ Center for Clinical Oncology, Okayama University Hospital, Okayama, Japan.
⁹ Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan.
¹⁰ Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan.
¹¹ Department of Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
¹² Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
¹³ Department of Obstetrics and Gynecology, International University of Health and Welfare Narita Hospital, Chiba, Japan.
¹⁴ Department of Gynecology, Shizuoka Cancer Center, Shizuoka, Japan.
¹⁵ Department of Obstetrics and Gynecology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
¹⁶ Department of Oncology and Social Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
¹⁷ Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan.
¹⁸ Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan.
¹⁹ Department of Medical Oncology, NTT Medical Center Tokyo, Tokyo, Japan.
²⁰ Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
²¹ Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan.
²² Department of Nursing, Okayama University Hospital, Okayama, Japan.
²³ Department of Drug Information, Faculty of Pharmaceutical Sciences, Shonan University of Medical Sciences, Kanagawa, Japan.
²⁴ Department of Medical Oncology, Hirosaki University Graduate School of Medicine, Aomori, Japan.

PMID: 38755516
DOI: 10.1007/s10147-023-02461-4

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.

Keywords: Acute myeloid leukemia; G-CSF; Meta-analysis; Priming effect.