Neutropenic fever following cladribine therapy for symptomatic hairy-cell leukemia: predictive factors and effects of granulocyte-macrophage colony-stimulating factor.
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.
Juliusson
G
G
Department of Medicine, Huddinge Hospital, Sweden.
Lenkei
R
R
Tjønnfjord
G
G
Heldal
D
D
Liliemark
J
J
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
D017338:Cladribine; D016178:Granulocyte-Macrophage Colony-Stimulating Factor