Recombinant human granulocyte-macrophage colony-stimulating factor reverses neutropenia and reduces secondary infections in visceral leishmaniasis.
Twenty-four patients with acute visceral leishmaniasis and leukopenia (< 1500 neutrophils/mm3) due to Leishmania chagasi were studied, 4 in an open-label pilot study and 20 in a double-blind, placebo-controlled trial. Patients received granulocyte-macrophage colony-stimulating factor (GM-CSF), 5 micrograms/kg daily, or placebo for 10 days, plus 10-20 mg/kg pentavalent antimony daily for 20 days. In GM-CSF recipients, neutrophil counts increased threefold and fourfold over baseline at 5 and 10 days, respectively, and were significantly higher than those in placebo recipients (P < .02). Eosinophil and monocyte counts were significantly increase in GM-CSF recipients at 10 days (P < or = .03). Secondary infections occurred in 3 GM-CSF and in 8 placebo recipients (P = .04). All patients had complete resolution of their leishmaniasis at 3 months. Few adverse events were recorded. GM-CSF, 5 micrograms/kg daily for 10 days, was safe, rapidly reversed neutropenia, and reduced the number of secondary infections in patients with leishmaniasis.
Federal University of Bahia, Salvador, Brazil.
R
R
Badaró
C
C
Nascimento
J S
JS
Carvalho
F
F
Badaró
D
D
Russo
J L
JL
Ho
S G
SG
Reed
W D
WD
Johnson
T C
TC
Jones
D000293:Adolescent; D000328:Adult; D000965:Antimony / Q000191:economics / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000191:economics / Q000627:therapeutic use; D001853:Bone Marrow / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000517:prevention & control*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D007958:Leukocyte Count; D008297:Male; D008536:Meglumine / Q000191:economics / Q000627:therapeutic use; D000077485:Meglumine Antimoniate; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy* / Q000209:etiology; D009942:Organometallic Compounds / Q000191:economics / Q000627:therapeutic use; D010865:Pilot Projects; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D012720:Severity of Illness Index
D000981:Antiprotozoal Agents; D009942:Organometallic Compounds; D011994:Recombinant Proteins; D008536:Meglumine; D000077485:Meglumine Antimoniate; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D000965:Antimony