Recombinant human granulocyte-macrophage colony-stimulating factor in combination with antibiotics in the treatment of febrile neutropenia in children.

Fever and neutropenia are life-threatening complications of chemotherapy in children with cancer. Prompt initiation of empiric broad-coverage antimicrobial therapy at the first signs of fever has reduced the mortality rates to about 2-5%. However, myelosuppression with febrile neutropenia is the major dose-limiting side effect of anticancer chemotherapy, results in prolonged hospitalization, and frequently delays the scheduled cycles of chemotherapy. Prophylactic use of hematopoietic growth factors has been shown to reduce the incidence of fever and infectious complications in children with cancer and neutropenia. Therapeutic use of recombinant human granulocyte-macrophage colony-stimulating factor (rHuGM-CSF) in combination with antibiotics in children with febrile neutropenia has also shown a clear beneficial effect. The number of hospital days due to treatment of febrile neutropenia, the number of days on broad-spectrum antibiotics and the duration of neutropenia were significantly reduced with the use of rHuGM-CSF. Importantly, rHuGM-CSF did not prolong the days with fever in children admitted with febrile neutropenia. In the treatment of documented fungal superinfection, it may be beneficial if rHuGM-CSF and an antifungal drug are used as combination therapy. rHuGM-CSF is non-toxic and well tolerated in children with cancer.