Granulocyte-macrophage colony-stimulating factor as infection prophylaxis in high-risk oncologic surgery.
BACKGROUND
A method of augmenting host defenses against bacterial pathogens could result in a decrease in postoperative infections. Given its effects on leukocyte proliferation and function, it is possible that prophylactic granulocyte-macrophage colony-stimulating factor (GM-CSF) could reduce the incidence and severity of infections in high-risk surgical patients. The current study was undertaken to determine the safety and hematologic effects of perioperative GM-CSF.


METHODS
Cancer patients undergoing operations with a high risk of postoperative infection were treated perioperatively for 10 days with subcutaneous GM-CSF. Cohorts were treated with GM-CSF at 125 micrograms/m2/day (12 patients) and 250 micrograms/m2/day (11 patients).


RESULTS
There were no severe or life-threatening toxicities associated with GM-CSF. Mean maximum neutrophil counts during the first 5 postoperative days were 16.3 +/- 9.14 and 24.5 +/- 7.60 at 125 and 250 micrograms/m2, respectively (P = 0.04). Only one wound infection was diagnosed during this study.


CONCLUSIONS
GM-CSF may be safely administered perioperatively at doses that augment neutrophil number and function. An ongoing randomized clinical trial will determine the impact of GM-CSF on postoperative infection.
Meropol
N J
NJ
Division of Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
Petrelli
N J
NJ
Lipman
B J
BJ
Rodriguez-Bigas
M
M
Hicks
W
W
Douglass
H O
HO
Smith
J L
JL
Rasey
M
M
Blumenson
L E
LE
Vaickus
L
L
Hayes
F A
FA
Agosti
J M
JM
D001424:Bacterial Infections / Q000517:prevention & control*; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D009369:Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D011292:Premedication; D012307:Risk Factors
D016178:Granulocyte-Macrophage Colony-Stimulating Factor