title: Neutropenic fever following cladribine therapy for symptomatic hairy-cell leukemia: predictive factors and effects of granulocyte-macrophage colony-stimulating factor.
abstract: BACKGROUND
  Neutropenic fever is the commonest complication of cladribine therapy for hairy-cell leukemia (HCL), leading to a 3% mortality rate. Our aim was to identify predictive factors and evaluate the effects of concomitant granulocyte-macrophage colony-stimulating factor (GM-CSF).
  
  
  METHODS
  We studied 102 patients with active HCL given cladribine for 7 days. Pretreatment parameters predicting neutropenic fever were analysed. Twelve patients at high risk for febrile complications also received 400 micrograms GM-CSF per day on days 1 through 21.
  
  
  RESULTS
  Pretreatment anemia, hypocholesterolemia, bone marrow differential with a high percentage of hairy cells and a low percentage of myelopoietic cells, low albumin, and high C-reactive protein predicted neutropenic fever. The addition of GM-CSF did not improve the kinetics of recovery for neutrophils, hemoglobin or platelets, as compared to matched control patients. However, GM-CSF significantly reduced cladribine-induced lymphopenia, but not the incidence of neutropenic fever.
  
  
  CONCLUSIONS
  Factors predicting febrile neutropenia were identified. GM-CSF protected from cladribine lymphotoxicity but did not improve neutropenia or febrile episodes.
authors.affiliation: Department of Medicine, Huddinge Hospital, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Juliusson
authors.forename: R
authors.initials: R
authors.lastname: Lenkei
authors.forename: G
authors.initials: G
authors.lastname: Tjønnfjord
authors.forename: D
authors.initials: D
authors.lastname: Heldal
authors.forename: J
authors.initials: J
authors.lastname: Liliemark
mesh_terms: D017338:Cladribine / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000139:chemically induced / Q000517:prevention & control*; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D007943:Leukemia, Hairy Cell / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control*; D012307:Risk Factors; D016176:T-Lymphocyte Subsets / Q000378:metabolism
chemical_list: D017338:Cladribine; D016178:Granulocyte-Macrophage Colony-Stimulating Factor