© 1995 by Oxford University Press
Journal of the National Cancer Institute, Vol. 87, No. 11, 803-808,
June 7, 1995
© 1995 Oxford University Press
Improving Treatment of Chemotherapy-Induced Neutropenic Fever by Administration of Colony-Stimulating Factors
Division of Medical Oncology, Hospital Universitario 12 de Octubre Madrid, Spain
Correspondence to present address: J. I. Mayordomo, M.D., Ph.D., Department of Surgery, W. 1540 Biomedical Science Tower, University of Pittsburgh, Pittsburgh, PA 15261
BACKGROUND: Several randomized trials have tested the use of granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GMCSF) in relieving chemotherapy-induced bone marrow suppression. However, the use of CSFs in the treatment of neutropenic fever remains virtually unexplored.
PURPOSE: This study evaluated the benefits of adding CSF therapy to the standard antibiotic treatments given to cancer patients for chemotherapy-induced neutropenic fever. The usefulness of CSFs was quantified in terms of reducing the following: (a) the duration of neutropenia, (b) the length of hospitalization, and (c) the overall cost of the treatment.
METHODS: A randomized trial was conducted to test whether the administration of either G-CSF or GM-CSF improved the outcome of standard antibiotic therapy (ceftazidime plus amikacin) in nonleukemic cancer patients with fever (>38 °C) and grade IV neutropenia (absolute neutrophil count [ANC] <500/mm3) induced by standard-dose chemotherapy. Of 121 patients who entered the trial, 39 received G-CSF (5 µg/kg body weight per day), 39 received GM-CSF (5 µg/kg body weight per day), and 43 received a placebo beginning just after the first dose of antibiotics. Treatments were continued for at least 5 days (7 days with clinically or microbiologically documented infections) or until 2 days after fever subsided and ANCs rose above 1000/mm3.
RESULTS: The median duration of grade IV neutropenia (ANC of <500/mm3) was 2 days in both CSF arms and 3 days in the placebo arm (P<.001). The median duration of neutropenia with an ANC of less than 1000/mm3 was also significantly shorter in patients receiving G-CSF or GM-CSF (P<.001). The median duration of fever was similar in the three arms. The median hospital stay was 5 days (range, 5–14 days) in the G-CSF arm, 5 days (range, 5–10 days) in the GM-CSF arm, and 7 days (range, 5–34 days) in the placebo arm (P<.001). The median time on CSF was 4 days in both treatment arms. The mean cost of overall treatment was reduced by $1300–$1400 in the CSF arms compared with the placebo arm (P = .11 for G-CSF versus placebo; P = .06 for GM-CSF versus placebo; P = .7 for GCSF versus GM-CSF). Conclusions: Adding G-CSF or GMCSF therapy to antibiotic treatment shortens the duration of neutropenia and the duration of hospitalization in patients with neutropenic fever. A statistically nonsignificant trend toward lower cost was observed in the CSF arms as compared with the placebo arm.
IMPLICATIONS: The benefits of CSFs to cancer patients with chemotherapy-induced neutropenic fever merit further evaluation in large randomized trials. [J Natl Cancer Inst 87:803–808, 1995]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  O. A.C. Clark, G. H. Lyman, A. A. Castro, L. G.O. Clark, and B. Djulbegovic Colony-Stimulating Factors for Chemotherapy-Induced Febrile Neutropenia: A Meta-Analysis of Randomized Controlled Trials J. Clin. Oncol., June 20, 2005; 23(18): 4198 - 4214. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. L Stanford, S. D Zondor, and E. Cobos Is pegfilgrastim appropriate for the treatment of established febrile neutropenia? Journal of Oncology Pharmacy Practice, June 1, 2003; 9(2-3): 113 - 119. [Abstract] [PDF]
|
|
|
|
|
|
C. Patte, A. Laplanche, A. I. Bertozzi, A. Baruchel, D. Frappaz, C. Schmitt, F. Mechinaud, B. Nelken, P. Boutard, and J. Michon Granulocyte Colony-Stimulating Factor in Induction Treatment of Children With Non-Hodgkin's Lymphoma: A Randomized Study of the French Society of Pediatric Oncology J. Clin. Oncol., January 15, 2002; 20(2): 441 - 448. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Garcia-Carbonero, J. I. Mayordomo, M. V. Tornamira, M. Lopez-Brea, A. Rueda, V. Guillem, A. Arcediano, A. Yubero, F. Ribera, C. Gomez, et al. Granulocyte Colony-Stimulating Factor in the Treatment of High-Risk Febrile Neutropenia: a Multicenter Randomized Trial J Natl Cancer Inst, January 3, 2001; 93(1): 31 - 38. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. R. Donowitz, D. G. Maki, C. J. Crnich, P. G. Pappas, and K. V.I. Rolston Infections in the Neutropenic Patient-- New Views of an Old Problem Hematology, January 1, 2001; 2001(1): 113 - 139. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Ozer, J. O. Armitage, C. L. Bennett, J. Crawford, G. D. Demetri, P. A. Pizzo, C. A. Schiffer, T. J. Smith, G. Somlo, J. C. Wade, et al. 2000 Update of Recommendations for the Use of Hematopoietic Colony-Stimulating Factors: Evidence-Based, Clinical Practice Guidelines J. Clin. Oncol., October 20, 2000; 18(20): 3558 - 3585. [Full Text] [PDF]
|
|
|
|
|
|
N. L. Kobrinsky, D. E. Sjolander, M. S. Cheang, R. Levitt, and P. D. Steen Granulocyte-Macrophage Colony-Stimulating Factor Treatment Before Doxorubicin and Cyclophosphamide Chemotherapy Priming in Women With Early-Stage Breast Cancer J. Clin. Oncol., November 1, 1999; 17(11): 3426 - 3430. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. M. Mueller, C. C. Herold-Mende, D. Riede, M. Lange, H.-H. Steiner, and N. E. Fusenig Autocrine Growth Regulation by Granulocyte Colony-Stimulating Factor and Granulocyte Macrophage Colony-Stimulating Factor in Human Gliomas with Tumor Progression Am. J. Pathol., November 1, 1999; 155(5): 1557 - 1567. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. C. Hartmann, L. K. Tschetter, T. M. Habermann, L. P. Ebbert, P. S. Johnson, J. A. Mailliard, R. Levitt, V. J. Suman, T. E. Witzig, H.S. Wieand, et al. Granulocyte Colony-Stimulating Factor in Severe Chemotherapy-Induced Afebrile Neutropenia N. Engl. J. Med., June 19, 1997; 336(25): 1776 - 1780. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C.-H. Pui, J. M. Boyett, W. T. Hughes, G. K. Rivera, M. L. Hancock, J. T. Sandlund, T. Synold, M. V. Relling, R. C. Ribeiro, W. M. Crist, et al. Human Granulocyte Colony-Stimulating Factor after Induction Chemotherapy in Children with Acute Lymphoblastic Leukemia N. Engl. J. Med., June 19, 1997; 336(25): 1781 - 1787. [Abstract] [Full Text] [PDF]
|
|