Neutrophils recovery

The CSFs should not be used routinely for treatment of febrile neutropenia in conjunction with antimicrobial therapy.5 However, the use of CSFs in certain high-risk patients with hypotension, documented fungal infection, pneumonia, or sepsis is reasonable. A recent meta-analysis demonstrated that hospitalization and neutrophil recovery are shortened and that infection-related mortality is marginally improved.14 As with prophylactic use of these agents, cost considerations limit their use to high-risk patients. 

Leukine (sargramostim, GM-CSF) Autologous bone marrow transplantation Neutrophil recovery after bone marrow transplantation Berlex Labs... 

G-CSF and GM-CSF have also found application after allogenic or autologous bone marrow transplantation, to accelerate neutrophil recovery. (Allogenic means that donor and recipient are different individuals, and autologous means that donor and recipient are the same.)... 

McNiece L, Jones R., Bearman S., Cagnoni P., Nieto Y., Franklin W., Ryder J., Steele A., Stoltz J., Russell P., McDermitt J., Hogan C., Murphy J., Shpall E. (2000) Ex vivo expanded peripheral blood progenitor cells provide rapid neutrophil recovery after high dose chemotherapy in patients with breast cancer 96 (9) 3001-3007. 

Neutropenia is a common adverse effect of the cytotoxic drugs used to treat cancer and increases the risk of serious infection in patients receiving chemotherapy. Unlike the treatment of anemia and thrombocytopenia, transfusion of neutropenic patients with granulocytes collected from donors is performed rarely and with limited success. The introduction of G-CSF in 1991 represented a milestone in the treatment of chemotherapy-induced neutropenia. This growth factor dramatically accelerates the rate of neutrophil recovery after dose-intensive myelosuppressive chemotherapy (Figure 33-5). It reduces the duration of neutropenia and usually raises the nadir count, the lowest neutrophil count seen following a cycle of chemotherapy. 

Outcomes have been reported in a consecutive series of 91 patients hospitalized with non-chemotherapy drug-induced agranulocytosis from 1985-2000 (34). All but two survived. Antithyroid drugs were the cause of agranulocytosis in 20% of cases. Univariate and multivariate analyses failed to reveal a specific effect of antithyroid drugs on the time to neutrophil recovery. In contrast, hemopoietic growth factor treatment was associated with speedier hematological recovery. 

Farese AM,Yang B-B, Roskos L, Stead RB, MacVittie TJ Pegfilgrastim, a sustained-duration form of filgrastim, significantly improves neutrophil recovery after autologous marrow transplantation in rhesus macaques. Bone Marrow Transplant. 2003 32 399-404. 

George S,Yunus F, Case D, et al. Fixed-dose pegfilgrastim is safe and allows neutrophil recovery in patients with non-Hodgkirfs lymphoma. Leuk. Lymphoma 2003 70 1691-1696. 

A scoring system for mucositis has been proposed and vahdated (45) and multivariate analysis has been used to identify contributory factors (46). A diagnosis of leukemia, the use of total body irradiation or allogenic transplantation in treatment, or delayed neutrophil recovery were associated with an increased incidence of oral mucositis. 

Sheridan WP, Morstyn G, Wolf M, Dodds A, Lusk J, Maher D, Layton JE, Green MD, Souza L, Fox RM. Granulocyte colony-stimulating factor and neutrophil recovery after high-dose chemotherapy and autologous bone marrow transplantation. Lancet 1989 2(8668) 891-5. 

White K, Cebon J. Transient hypoxaemia during neutrophil recovery in febrile patients. Lancet 1995 345(8956) 1022-4. 

The safety and efficacy of oral cyclodextrin itraconazole (5 mg/kg/day) as antifungal prophylaxis has been assessed in an open trial in 103 neutropenic children (median age 5 years range 0-15 years) (53). Prophylaxis was started at least 7 days before the onset of neutropenia and continued until neutrophil recovery. Of the 103 patients, only 47 completed the course of prophylaxis 27 withdrew because of poor compliance, 19 because of adverse events, and 10 for other reasons. Serious adverse events (other than death) occurred in 21 patients, including convulsions (n = 7), suspected drug interactions (n = 6), abdominal pain (n — 4), and constipation n — 4). The most common adverse events considered definitely or possibly related to itraconazole were vomiting (n = 12), abnormal liver function (n — 5), and abdominal pain (n = 3). Tolerabihty of the study medication at end-point was rated as good (55%), moderate (11%), poor (17%), or unacceptable (17%). There were no unexpected problems of safety or tolerability. 

Evidence for the effectiveness of these agents comes from their use in cancer patients, human radiation accident victims, and animal studies. Filgrastim and sargramostim have hastened neutrophil recovery 3-6 days in patients following... 

Absolute neutrophil count <0.500x10 cells L. Antibiotic therapy should be continued until neutrophil recovery has occurred. Follow Infectious Diseases Society of America guidelines (17) for febrile neutropenia if fever develops while the patient is taking prophylactic medication Tf resources are available... 

The use of antibacterial prophylaxis remains controversial owing to a lack of consistent efficacy, potential for development of resistant bacteria, high cost, and lack of impact on patient survival. Therefore, antibacterial prophylaxis is not recommended routinely for all neutropenic patients. Prophylaxis (with trimethoprim-sulfamethoxazole or quinolone-penicillin) generally is indicated for patients expected to be profoundly neutropenic for more than 1 week, such as HSCT patients. Additional risk factors that may provide justification for prophylaxis include mucous membrane or skin lesions, presence of indwelling catheters, need for instrumentation, severe periodontal disease, or other risk factors. Neutrophil recovery eliminates the need for continued prophylaxis, and recovery may be facilitated by use of... 

Several studies have evaluated the use of filgrastim and sargramostim in HSCT patients in an effort to speed bone marrow recovery, to reduce the period of neutropenia, and to decrease infectious complications. Although the time to neutrophil recovery was consistently decreased, these studies failed to show significant differences in infection rates, transplant-related mortality, or overall survival. The use of CSFs appears to be safe, but their use in HSCT patients has not been formally recommended because of lack of clear benefits. ... 

Reference Drug Enhanced Neutrophil Recovery Other Benefits Related to Colony-Stimulating Factor Therapy... 

Fig. 8. BB-10010 dose-dependent trend of better neutrophil recovery in patients receiving FAC chemotherapy. Mean neutrophil counts during cycle 6 of FAC chemotherapy, presented as a percentage of each patient s pretreatment neutrophil coimt.

Haematologic A retrospective study of 33 patients treated at the First Affiliated Hospital of South China for ATD-induced agranulocytosis classified this condition into two distinct groups Type 1 with no granulocytic cells (20 pts) or Type 2 with hypercellular bone marrow expressing granulocytic cells with abnormal or arrested maturation arrest (13 pts). Neutrophil recovery and fever duration was nearly twice as long for Type 1 compared to Type 2 and the... 

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