Responsiveness to G-CSF before leukopenia predicts defense to infection in high-dose chemotherapy recipients.
An active assessment of the host capacity to prevent infection during myelosuppression should be beneficial in patients receiving high-dose chemotherapy. A single dose of granulocyte colony-stimulating factor (G-CSF) (5 microg/kg) was given to 57 patients with multiple myeloma early after the completion of 85 high-dose chemotherapy (melphalan 200 mg/m2) courses. This provoked a highly variable white blood cell (WBC) peak after 12 to 14 hours. The median WBC count was 21,000/microL (range, 6400-60,600/microL) after a first high-dose therapy (n = 50) and 13,500/microL (range, 4700-24,800/microL) after a second high-dose therapy (n = 35). The responsiveness to single G-CSF was associated with the risk of infection during subsequent cytopenia (P =.003). This association was significant after adjustment for neutropenia duration. Notably, the result of testing G-CSF responsiveness was opportunely available before the onset of leukopenia, and G-CSF responsiveness was more informative than neutropenia duration regarding the risk of infection. Furthermore, there was an association between the responsiveness to G-CSF and stem cell engraftment (P <.005), which remained significant after adjustment for the number of transplanted CD34+ cells. Our results show for the first time that G-CSF potentially could be used for an early in vivo assessment of defense to infection in recipients of high-dose chemotherapy.
Straka
Christian
C
Medizinische Klinik-Innenstadt, Klinikum der Universität München, München, Germany. christian.straka@med.uni-muenchen.de
Oduncu
Fuat
F
Hinke
Axel
A
Einsele
Hermann
H
Drexler
Evi
E
Schnabel
Brigitte
B
Arseniev
Lubomir
L
Walther
Jochem
J
König
August
A
Emmerich
Bertold
B
D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000737:chemistry; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001803:Blood Transfusion; D002986:Clinical Trials as Topic; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006412:Hematopoietic Stem Cells / Q000166:cytology; D006801:Humans; D007958:Leukocyte Count; D007962:Leukocytes / Q000166:cytology / Q000187:drug effects; D007970:Leukopenia / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D009369:Neoplasms / Q000188:drug therapy*; D011379:Prognosis; D012306:Risk; D013234:Stem Cells / Q000166:cytology; D013997:Time Factors
D018952:Antigens, CD34; D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor