A CASE-CONTROL RETROSPECTIVE STUDY OF THE EFFICACY OF GRANULOCYTE-COLONY-STIMULATING FACTOR IN CHILDREN WITH NEUROBLASTOMA

Purpose: We conducted a retrospective case-control study to examine th e effect of granulocyte-colony-stimulating factor (G-CSF) on the durat ion of the neutrophil nadir and other clinical parameters in children with neuroblastoma. Patients and Methods: We retrospectively reviewed 85 courses of the same chemotherapy in 16 consecutive neuroblastoma pa tients. The first nine patients received no growth factor and the foll owing seven patients received G-CSF. Data obtained included days of ne utropenia, fever rate and duration, hospitalization rate and duration, antibiotic duration, and infection rate. Results: Patients who receiv ed G-CSF had a significant decrease in the period of neutropenia (mean 5.4 +/- 2.6 days per course vs. 11.4 +/- 4.1 days per course in the c ontrol group; p < 0.001). There were no statistically significant diff erences in episodes of fever per course, rate of hospitalization per c ourse, duration of hospitalization, or duration of antibiotic therapy. Control patients had documented infections during 16% (nine of 56) of their chemotherapy courses, whereas the patients receiving G-CSF had infections during 7% (two of 29) of their courses, but this difference was not statistically significant (p = 0.318). We calculated that a s tudy of 220 courses in each group would be needed to have adequate pow er to confirm that this difference is statistically significant. Concl usions: The administration of G-CSF in this patient population did res ult in fewer days of neutropenia, a finding that has been reported pre viously in several adult studies. However, we conclude that the clinic al benefit of more rapid hematologic recovery in children remains unce rtain and deserves further investigation in a large, prospective multi center trial.