title: Long-term follow-up of patients with invasive fungal disease who received adjunctive therapy with recombinant human macrophage colony-stimulating factor.
abstract: Mortality of bone marrow transplant (BMT) patients who develop invasive fungal infection is greater than 80%. Long-term follow-up of 46 consecutive BMT patients who received recombinant human macrophage colony-stimulating factor (rhM-CSF) as adjunctive therapy with standard antifungal treatment who were entered into phase I/II trials at The Fred Hutchinson Cancer Research Center is reported. rhM-CSF (100 micrograms/m2 to 2,000 micrograms/m2; Chiron/Cetus Corporation, Emeryville, CA) was administered from day 0 to 28 after determination of progressive fungal disease. Results of long-term follow-up of fungal infection, relapse, and survival were compared with 58 similar historical controls. Multivariable analysis of the patients who received rhM-CSF showed two factors that significantly correlated with poor survival: Karnofsky score < or = 20% and Aspergillus infection. Overall, survival of patients who received rhM-CSF was greater than that of historical patients (27% v 5%) and was entirely because of a 50% survival rate in patients with Candida infection and Karnofsky scores greater than 20%. Prospective, randomized, controlled trials to determine efficiency of rhM-CSF are indicated and should be directed at patients with invasive candidiasis.
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: J
authors.initials: J
authors.lastname: Nemunaitis
authors.forename: K
authors.initials: K
authors.lastname: Shannon-Dorcy
authors.forename: F R
authors.initials: FR
authors.lastname: Appelbaum
authors.forename: J
authors.initials: J
authors.lastname: Meyers
authors.forename: A
authors.initials: A
authors.lastname: Owens
authors.forename: R
authors.initials: R
authors.lastname: Day
authors.forename: D
authors.initials: D
authors.lastname: Ando
authors.forename: C
authors.initials: C
authors.lastname: O'Neill
authors.forename: D
authors.initials: D
authors.lastname: Buckner
authors.forename: J
authors.initials: J
authors.lastname: Singer
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002648:Child; D005260:Female; D006801:Humans; D016173:Macrophage Colony-Stimulating Factor / Q000627:therapeutic use* / Q000633:toxicity; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D010431:Pentoxifylline / Q000494:pharmacology; D010976:Platelet Count / Q000187:drug effects; D011994:Recombinant Proteins / Q000627:therapeutic use; D015996:Survival Rate
chemical_list: D011994:Recombinant Proteins; D016173:Macrophage Colony-Stimulating Factor; D010431:Pentoxifylline