Recombinant human granulocyte-macrophage colony-stimulating factor in septic neutropenic pediatric cancer patients: Detection of circulating hematopoietic precursor cells correlates with rapid granulocyte recovery
✍ Scribed by Fink, Franz-Martin ;Maurer-Dengg, Kathrin ;Fritsch, Gerhard ;Mann, Georg ;Zoubek, Andreas ;Falk, Markus ;Gadner, Helmut
- Publisher
- John Wiley and Sons
- Year
- 1995
- Tongue
- English
- Weight
- 756 KB
- Volume
- 25
- Category
- Article
- ISSN
- 0098-1532
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✦ Synopsis
Abstract
Cycling intensive chemotherapy currently used to treat pediatric solid tumors induces severe neutropenia. Prolonged neutropenia is a major risk factor for septic death which occurs in up to 5% of febrile or septic neutropenic episodes. We treated 18 neutropenic pediatric cancer patients (eight females, 10 males) during 30 febrile and/or septic episodes with single daily doses of E. coli‐derived non‐glycosylated recombinant human granulocyte‐macrophage colony‐stimulating factor (rh‐GM‐CSF, 5 μg per kg of body weight). The cytokine was administered for a median period of 6.5 days (2–12 days). Analysis of circulating hematopoietic progenitor cells was performed at day 1 (baseline) and day 5 of rh‐GM‐CSF treatment and included flow cytometric CD34 analysis as well as the methylcellulose‐based clonogenic assay.
Prompt hematopoietic recovery and resolution of septic problems was observed in all children. The counts of leukocytes (WBC), absolute neutrophils (ANC), and platelets (PLT) rose above 1,000/μL, 1,000/μL, and 50,000/μL within 4 days (0–9), 5.5 days (2–13), and 6 days (0–14), respectively. Faster granulocyte recovery and improved recruitment of circulating hemopoietic precursors was observed in children with detectable amounts (>0.1%) of CD34‐positive mononuclear cells prior to rh‐GM‐CSF treatment.
We conclude that, to some extent, the efficacy of rh‐GM‐CSF treatment in neutropenic cancer patients is influenced by the hematopoietic recovery status on the progenitor cell level. Although they respond more slowly to the treatment, patients without circulating CD34‐positive progenitor cells may gain most from growth factor therapy. Rh‐GM‐CSF can be safely administered to febrile and/or septic neutropenic children treated for cancer. © 1995 Wiley‐Liss, Inc.