title: Testing G-CSF responsiveness predicts the individual susceptibility to infection and consecutive treatment in recipients of high-dose chemotherapy.
abstract: The individual risk of infection and requirements for medical treatment after high-dose chemotherapy have been unpredictable. In this prospective, multicenter, open-label study we investigated the potential of granulocyte colony-stimulating factor (G-CSF) responsiveness as a predictor. A total of 168 patients with multiple myeloma or lymphoma received a single dose of subcutaneous G-CSF (lenograstim, 263 μg) after high-dose chemotherapy. Highly variable leukocyte peaks were measured and grouped as low (quartile 1; leukocytes 100-10 100/μL), medium (quartile 2; leukocytes > 10 100-18 300/μL), and high (quartiles 3/4; leukocytes > 18 300-44 800/μL). G-CSF responsiveness (low vs medium vs high) was inversely correlated with febrile neutropenia (77% vs 60% vs 48%; P = .0037); the rate of infection, including fever of unknown origin (91% vs 67% vs 54%; P < .0001); days with intravenous antibiotics (9 vs 6 vs 5; P < .0001); and antifungal therapy (P = .042). In multivariate analysis, G-CSF responsiveness remained the only factor significantly associated with infection (P = .016). In addition, G-CSF responsiveness was inversely correlated with grade 3/4 oral mucositis (67% vs 33% vs 23%; P < .0001). G-CSF responsiveness appears as a signature of the myeloid marrow reserve predicting defense against neutropenic infection after intensive chemotherapy. This study is registered at http://www.clinicaltrials.gov as NCT01085058.
authors.affiliation: Schön Klinik Starnberger See, Berg, Germany, and Medizinische Klinik Innenstadt der Universität München, Munich, Germany. cstraka@schoen-kliniken.de
authors.forename: Christian
authors.initials: C
authors.lastname: Straka
authors.forename: Michael
authors.initials: M
authors.lastname: Sandherr
authors.forename: Hans
authors.initials: H
authors.lastname: Salwender
authors.forename: Hannes
authors.initials: H
authors.lastname: Wandt
authors.forename: Bernd
authors.initials: B
authors.lastname: Metzner
authors.forename: Kai
authors.initials: K
authors.lastname: Hübel
authors.forename: Gerda
authors.initials: G
authors.lastname: Silling
authors.forename: Marcus
authors.initials: M
authors.lastname: Hentrich
authors.forename: Daniel
authors.initials: D
authors.lastname: Franke
authors.forename: Rainer
authors.initials: R
authors.lastname: Schwerdtfeger
authors.forename: Mathias
authors.initials: M
authors.lastname: Freund
authors.forename: Orhan
authors.initials: O
authors.lastname: Sezer
authors.forename: Alexander
authors.initials: A
authors.lastname: Giagounidis
authors.forename: Gerhard
authors.initials: G
authors.lastname: Ehninger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Grimminger
authors.forename: Andreas
authors.initials: A
authors.lastname: Engert
authors.forename: Günter
authors.initials: G
authors.lastname: Schlimok
authors.forename: Christof
authors.initials: C
authors.lastname: Scheid
authors.forename: Peter
authors.initials: P
authors.lastname: Hellmann
authors.forename: Harald
authors.initials: H
authors.lastname: Heinisch
authors.forename: Hermann
authors.initials: H
authors.lastname: Einsele
authors.forename: Axel
authors.initials: A
authors.lastname: Hinke
authors.forename: Bertold
authors.initials: B
authors.lastname: Emmerich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor; D006801:Humans; D007239:Infections / Q000097:blood / Q000209:etiology*; D000078224:Lenograstim; D008223:Lymphoma / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D015999:Multivariate Analysis; D009503:Neutropenia / Q000097:blood / Q000209:etiology; D036102:Peripheral Blood Stem Cell Transplantation; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011994:Recombinant Proteins; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000078224:Lenograstim; D008558:Melphalan