IMPROVING TREATMENT OF CHEMOTHERAPY-INDUCED NEUTROPENIC FEVER BY ADMINISTRATION OF COLONY-STIMULATING FACTORS

被引：96

作者：

MAYORDOMO, JI ^{[1
]}

RIVERA, F ^{[1
]}

DIAZPUENTE, MT ^{[1
]}

LIANES, P ^{[1
]}

COLOMER, R ^{[1
]}

LOPEZBREA, M ^{[1
]}

LOPEZ, E ^{[1
]}

PAZARES, L ^{[1
]}

HITT, R ^{[1
]}

GARCIARIBAS, I ^{[1
]}

CUBEDO, R ^{[1
]}

ALONSO, S ^{[1
]}

CORTESFUNES, H ^{[1
]}

机构：

[1] HOSP UNIV 12 DE OCTUBRE,DIV MED ONCOL,MADRID,SPAIN

来源：

JOURNAL OF THE NATIONAL CANCER INSTITUTE | 1995年 / 87卷 / 11期

关键词：

D O I：

10.1093/jnci/87.11.803

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

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 degrees C) and grade IV neutropenia (absolute neutrophil count [ANC] <500/mm(3)) induced by standard-dose chemotherapy. Of 121 patients who entered the trial, 39 received G-CSF (5 mu g/kg body weight per day), 39 received GM-CSF (5 mu g/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/mm(3). Results: The median duration of grade IV neutropenia (ANC of <500/mm(3)) 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/mm(3) 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 G-CSF 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.

引用

页码：803 / 808

页数：6

共 43 条

[1]

Pizzo P.A., Management of fever in patients with cancer and treatment-induced neutropenia [see comment citations in Medline], N Engl J Med, 328, pp. 1323-1332, (1993)

[2]

Bodey G.P., Buckley M., Sathe Y.S., Et al., Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia, Ann Intern Med, 64, pp. 328-340, (1966)

[3]

Ramphal R., Bolger M., Obion D.J., Et al., Vancomycin is not an essential component of the initial empiric treatment regimen for febrile neutropenic patients receiving ceftazidime: A randomized prospective study, Anti-Microb Agents Chemother, 36, pp. 1052-1067, (1992)

[4]

Comelissen J.J., De Graeff A., Verdonck L.F., Et al., Imipenem versus gentamicin combined with either cefuroxime or cephalotin as initial therapy for febrile neutropenic patients, Antimicrob Agents Chemother, 36, pp. 801-807, (1992)

[5]

Engervall P.A., Stiemstedt G.T., Gunther G.C., Et al., Tnmethoprim-sulfa-metoxazole plus amikacin as first-line therapy and imipenem/cilastatin as second empirical therapy in febrile neutropenic patients with hematological disorders, J Chemother, 4, pp. 99-106, (1992)

[6]

Kelsey S.M., Shaw E., Newland A.C., Aztreonam plus vancomycin versus gentamicin plus piperacillin as empirical therapy for the treatment of fever in neutropenic patients: A randomised controlled study, J Chemother, 4, pp. 107-113, (1992)

[7]

Malik I.A., Abbas Z., Karim M., Randomised comparison of oral ofloxacin alone with combination of parenteral antibiotics in neutropenic febrile patients, Lancet, 239, pp. 1092-1096, (1992)

[8]

Yataganas X., Rombos Y., Vayopoulos G., Et al., Randomized clinical trial comparing ceftriaxone/amikacin versus ceftazidime/amikacin as initial therapy of febrile episodes in neutropenic patients, Chemotherapy, 37, pp. 376-381, (1991)

[9]

Schmid L., Jeschko M., Wilder-Smith C., Et al., Ceftriaxone and amikacin versus ceftazidime and amikacin in febrile granulocytopenia, Chemotherapy, 37, pp. 346-352, (1991)

[10]

Rolston K.V., Berkey P., Bodey G.P., Et al., A comparison of imipenem to ceftazidime with or without amikacin as empiric therapy in febrile neutropenic patients, Arch Intern Med, 152, pp. 283-291, (1992)

← 1 2 3 4 5 →