The effect of concomitant use of Colony-Stimulating factors on bleomycin pulmonary toxicity – A systematic review and meta-analysis

Pulmonary toxicity is the most dangerous side effect of bleomycin.•Modulation of bleomycin induced pulmonary toxicity with colony-stimulating factors (CSF) have been reported.•Concomitant use of CSF and bleomycin increases the risk of pulmonary toxicity. Changes in the incidence of bleomycin pulmonary toxicity (BPT) as a result of adding colony-stimulating factors (CSF) to bleomycin regimens has been investigated in numerous studies. We performed a systematic review and meta-analysis to assess the outcomes of these studies. A systematic search was performed using Pubmed, Scopus, Web of Science, and Embase on April 2021. Studies evaluating the incidence of BPT in patients receiving bleomycin with and without CSF were included. In addition, meta-analysis was performed by pooling odds ratios using R. Out of 340 obtained records, our qualitative and quantitative analysis included 3234 and 1956 patients from 22 and 14 studies, respectively. The quantitative synthesis showed that addition of CSF significantly increased the risk of BPT incidence (OR = 1.82, 95 % CI: 1.37–2.40, p