Stem Cells, Vol 13, 201-205, Copyright © 1995 by AlphaMed Press
Recombinant human granulocyte-macrophage colony-stimulating factor in combination with antibiotics in the treatment of febrile neutropenia in children
P Riikonen
Kuopio University Hospital, Division of Pediatric Hematology-Oncology, Finland.
Fever and neutropenia are life-threatening complications of chemotherapy in
children with cancer. Prompt initiation of empiric broad-coverage
antimicrobial therapy at the first signs of fever has reduced the mortality
rates to about 2-5%. However, myelosuppression with febrile neutropenia is
the major dose-limiting side effect of anticancer chemotherapy, results in
prolonged hospitalization, and frequently delays the scheduled cycles of
chemotherapy. Prophylactic use of hematopoietic growth factors has been
shown to reduce the incidence of fever and infectious complications in
children with cancer and neutropenia. Therapeutic use of recombinant human
granulocyte- macrophage colony-stimulating factor (rHuGM-CSF) in
combination with antibiotics in children with febrile neutropenia has also
shown a clear beneficial effect. The number of hospital days due to
treatment of febrile neutropenia, the number of days on broad-spectrum
antibiotics and the duration of neutropenia were significantly reduced with
the use of rHuGM-CSF. Importantly, rHuGM-CSF did not prolong the days with
fever in children admitted with febrile neutropenia. In the treatment of
documented fungal superinfection, it may be beneficial if rHuGM-CSF and an
antifungal drug are used as combination therapy. rHuGM-CSF is non-toxic and
well tolerated in children with cancer.
