The colony-stimulating factors and cancer

Abstract

The four colony-stimulating factors (CSFs) are glycoproteins that regulate the generation and some functions of infection-protective granulocytes and macrophages. Recombinant granulocyte-CSF (G-CSF) and granulocyte-macrophage-CSF (GM-CSF) have now been used to increase dangerously low white blood cell levels in many millions of cancer patients following chemotherapy. These CSFs also release haematopoietic stem cells to the peripheral blood, and these cells have now largely replaced bone marrow as more effective populations for transplantation to cancer patients who have treatment-induced bone marrow damage.

Figure 1. The biological actions of the CSFs

(a) CSF-stimulated colony formation in vitro by lineage-committed progenitor cells in mouse bone marrow, the sigmoid dose response indicating heterogeneity in the responsiveness of the progenitor cells. Adapted from Fig. 7.1, page 111 of REF. ; (b) In man, injected G-CSF not only increases peripheral blood neutrophil levels but increases peripheral blood progenitor cells 100-fold. Data shown are from two patients injected with 10µg/Kg G-CSF daily for 7 days. Adapted from Fig. 5, page 4443 of REF. ; (c) In transplanted cancer patients, the injection of G-CSF accelerates the recovery of neutrophil levels following chemotherapy, allowing a shorter duration of hospitalisation. Adapted from Fig. 1, page 893 of REF. ; (d) Transplantation of CSF-mobilised peripheral blood stem cells augments the rate of recovery of platelet levels following chemotherapy compared with control patients receiving marrow transplants. Adapted from Fig. 4, page 643 of REF. .