title: Infection risk in patients with small cell lung cancer receiving intensive chemotherapy and recombinant human granulocyte-macrophage colony-stimulating factor.
abstract: The effect of recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) was assessed in 17 patients with small cell lung cancer. GM-CSF was initially given alone by subcutaneous injection for 10 days at 50-500 micrograms/m2 per day. There was a significant rise in neutrophils and eosinophils and to a lesser extent in monocytes at all dose levels. During the next phase, patients received chemotherapy (etoposide, ifosfamide and doxorubicin), and GM-CSF was given on alternate cycles, the patients acting as their own controls, so that the amelioration of chemotherapy could be assessed. Despite partial abrogation of the neutropenia associated with chemotherapy (P = 0.04), GM-CSF failed to reduce the frequency of febrile episodes in association with neutropenia, with six episodes occurring on GM-CSF and seven while patients were not receiving GM-CSF after a total of 66 cycles of chemotherapy. After GM-CSF, there was a reduction in polymorph phagocytic ability and chemotaxis in 6/12 and 9/11 patients, respectively. Timed blood counts after GM-CSF administration showed that peak leucocytosis occurred at 8-12 h and fell to two-thirds of this level at 24 h. Toxicity consisting of lethargy, myalgia and bone pain occurred at all dose levels but was manageable. 2 patients had thromboembolism. This study failed to demonstrate a reduction in the infection risk associated with moderately intensive chemotherapy for small cell lung cancer despite the partial abrogation of neutropenia.
authors.affiliation: Medical Oncology Unit, Westmead Hospital, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Gurney
authors.forename: H
authors.initials: H
authors.lastname: Anderson
authors.forename: J
authors.initials: J
authors.lastname: Radford
authors.forename: M R
authors.initials: MR
authors.lastname: Potter
authors.forename: R
authors.initials: R
authors.lastname: Swindell
authors.forename: W
authors.initials: W
authors.lastname: Steward
authors.forename: A
authors.initials: A
authors.lastname: Kamthan
authors.forename: J
authors.initials: J
authors.lastname: Chang
authors.forename: J
authors.initials: J
authors.lastname: Weiner
authors.forename: N
authors.initials: N
authors.lastname: Thatcher
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D018288:Carcinoma, Small Cell / Q000628:therapy*; D002634:Chemotaxis, Leukocyte; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage*; D006801:Humans; D017053:Infection Control; D008175:Lung Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control*; D010587:Phagocytosis; D011994:Recombinant Proteins / Q000008:administration & dosage; D012307:Risk Factors; D013997:Time Factors
chemical_list: D011994:Recombinant Proteins; D016178:Granulocyte-Macrophage Colony-Stimulating Factor