title: Granulocyte macrophage colony-stimulating factor in 66 patients with myeloid or lymphoid neoplasms and recipients of hematopoietic stem cell transplantation with invasive fungal disease.
abstract: OBJECTIVE
  Adding granulocyte macrophage colony-stimulating factor (GM-CSF) may improve the response to antifungal therapy in immunosuppressed patients with invasive fungal disease (IFD).
  
  
  METHODS
  We retrospectively assessed 66 patients in whom GM-CSF was given during antifungal therapy.
  
  
  RESULTS
  Severe neutropenia (77%) and refractory/relapsed cancer (65%) were common in the group. Prior to GM-CSF therapy, 15% of patients received high-dose corticosteroids for a median of 30 ± 16 days [median cumulative dose (c.d.) 1,184 ± 1,019 mg], and 9 received steroids during GM-CSF therapy for a median of 16 ± 12 days (median c.d. 230 ± 1,314 mg). Mild toxic effects were noted in 9% of patients; there were no cases of cardiopulmonary toxicity. All-cause deaths were observed in 68% of patients and 48% died of progressive IFD. High-dose corticosteroids prior to GM-CSF (OR 24; 95% CI 2.21-264.9; p ≤ 0.009), GM-CSF started in the intensive care unit (OR 10; 95% CI 1.66-63.8; p ≤ 0.01), concurrent granulocyte transfusions (OR 5; 95% CI 1.27-16.8; p ≤ 0.02) and proven/probable IFD (OR 4; 95% CI 1-16.2; p ≤ 0.05) predicted antifungal treatment failure.
  
  
  CONCLUSIONS
  GM-CSF adjuvant therapy was tolerated without serous toxicity and antifungal treatment failure remained a challenge in patients treated with high-dose systemic corticosteroids.
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX, USA. amar.safdar@nyumc.org
authors.forename: Amar
authors.initials: A
authors.lastname: Safdar
authors.forename: Gilhen
authors.initials: G
authors.lastname: Rodriguez
authors.forename: Jorge
authors.initials: J
authors.lastname: Zuniga
authors.forename: Fadi
authors.initials: F
authors.lastname: Al Akhrass
authors.forename: Georgia
authors.initials: G
authors.lastname: Georgescu
authors.forename: Anupam
authors.initials: A
authors.lastname: Pande
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D002648:Child; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016867:Immunocompromised Host; D007945:Leukemia, Lymphoid / Q000150:complications / Q000628:therapy*; D007951:Leukemia, Myeloid / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents; D016178:Granulocyte-Macrophage Colony-Stimulating Factor