Reduction of infection rates in cancer patients associated with the use of haematopoietic growth factors.

As the risk of infection associated with chemotherapy is related to the depth of the fall in neutrophil counts, protection from neutropenia has been used as an endpoint for growth factors in this setting. However, the functional status of these and other myeloid cells are also important. Therefore, more direct measurements of clinical improvement will also be useful. Several studies have suggested that the use of granulocyte-macrophage colony-stimulating factor (GM-CSF) can result in improvements in hospital stay, days of fever, antibiotic use and thrombocytopenia. Similar findings have been confirmed by our own work which indicates that GM-CSF not only shortens the period of leukopenia, but also reduces the complications of infection. More sensitive and appropriate endpoints should be included in future trials, including rate of and survival from infection as well as overall and disease-free survival.