Seventeen RCTs (n=3,493) were included.
Nine studies scored 2 or less on the Jadad scale and were consider low-quality studies. Five studies described blinding, four described the method of randomisation and seven described withdrawals.
G-CSF was associated with a statistically significant reduction in the number of patients with one or more episodes of FN compared with control (15 studies, n=3,182): 22.4% versus 39.5% (random-effects RR 0.54, 95% CI: 0.43, 0.67, p<0.0001). There was a significant reduction with G-CSF in FN for all age groups, blinded and unblinded studies, and for studies permitting secondary prophylaxis with G-CSF in control groups.
G-CSF was associated with a statistically significant increase in bone and musculoskeletal pain compared with control (14 studies, n=3,029): 19.6% versus 10.4% (random-effects RR 4.023, 95% CI: 2.16, 7.52, p<0.0001).
G-CSF was associated with a statistically significant reduction in infection-related mortality (12 studies, n=2,917): 1.5% versus 2.8% (RR 0.55, 95% CI: 0.34, 0.90, p=0.018). It was also associated with a statistically significant reduction in early mortality (13 studies, n=3,122): 3.4% versus 5.7% (RR 0.60, 95% CI: 0.43, 0.83, p=0.002). Fixed-effect models were used for both of these analyses (I2=0%).
Average RDI (10 studies) ranged from 91.0 to 99.0% (mean 95.1, median 95.5) in patients receiving G-CSF and from 71.0 to 95.0% (mean 86.7, median 88.5) in control patients. The average difference between treatment groups was 8.4% (range: 2.8 to 20.0).