Colony-Stimulating Factor Therapy

Abstract: Febrile neutropenia is the major dose-limiting toxicity of anticancer chemotherapy in small cell lung cancer (SCLC). Nadir and duration of neutropenia have been correlated to the risk of developing sepsis [1], increasing healthcare costs and deteriorating quality of life. Despite empirical broad-spectrum antibiotic therapy at the onset of fever and dose reduction of chemotherapy during subsequent cycles, neutropenia-induced mortality remains important, particularly in patients with extensive SCLC. Multivariate analysis has shown that neutrophil recovery is a favourable prognostic factor in febrile neutropenia, independent of the use of antibiotic therapy [2]. The capacities of haematopoietic colony-stimulating factors (CSFs) to accelerate granular neutrophil recovery, as well as monocyte and eosinophil with granulocyte-macrophage CSFs (GM-CSFs), allows the hope of a reduction of haematological toxicity or an increased chemotherapy dose intensity. Primary prophylactic administration of granulocyte CSFs (G-CSFs), before the onset of neutropenia, reduced incidence of febrile neutropenia, length of hospitalization and antibiotic use subsequent to high-dose chemotherapy in SCLC patients [3, 4], whereas infectious mortality rate, response and survival rates were not improved. However, the cost-effectiveness of primary GCSF administration still remains controversial, with a high cost counterbalancing these benefits. G-CSF therapy combined with antibiotic therapy, in

Abstract: A 6-year-old white male had a myelodysplastic syndrome (refractory anemia with excess blasts in transformation) and was treated with high dose chemotherapy. A combined esterase stain of the marrow blasts showed granulocytic differentiation. Subsequently, persistent pancytopenia with a severely hypocellular bone marrow developed, which was treated with a combination of granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor. Sixteen days after the initiation of therapy, histologic examination of the bone marrow revealed a marked proliferation of histiocytes. To the best of the authors' knowledge, this is the first report of histiocytic proliferation in the bone marrow after colony-stimulating factor therapy.