GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR AS INFECTION PROPHYLAXIS IN HIGH-RISK ONCOLOGIC SURGERY

BACKGROUND: A method of augmenting host defenses against bacterial pat hogens could result in a decrease in postoperative infections. Given i ts effects on leukocyte proliferation and function, it is possible tha t prophylactic granulocyte-macrophage colony-stimulating factor (GM-CS F) could reduce the incidence and severity of infections in high-risk surgical patients. The current study was undertaken to determine the s afety and hematologic effects of perioperative GM-CSF. METHODS: Cancer patients undergoing operations with a high risk of postoperative infe ction were treated perioperatively for 10 days with subcutaneous GM-CS F. Cohorts were treated with GMCSF at 125 mu g/m(2)/day (12 patients) and 250 mu g/m(2)/day (11 patients). RESULTS: There were no severe or life-threatening toxicities associated with GM-CSF. Mean maximum neutr ophil counts during the first 5 postoperative days were 16.3 +/- 9.14 and 24.5 +/- 7.60 at 125 and 250 mu g/m(2), respectively (P = 0.04). O nly one wound infection was diagnosed during this study. CONCLUSIONS: GM-CSF may be safely administered perioperatively at doses that augmen t neutrophil number and function. An ongoing randomized clinical trial will determine the impact of GM-CSF on postoperative infection.