CYTOKINES IN THE MANAGEMENT OF INFECTIOUS COMPLICATIONS IN CHILDREN WITH CANCER

Children receiving cancer therapy are susceptible to infectious compli cations that compromise the ability to deliver therapy in a timely man ner and may adversely affect outcome. The most significant risk factor is severe neutropenia. The recently discovered myeloid growth factors have the potential to abrogate neutropenia post-intensive therapy and to possibly reduce infectious complications. In addition, these agent s can augment effector cell response to established infection. Recentl y, in various clinical trials, the use of cytokines has been shown to decrease the incidence and severity of infectious complications in ped iatric patients, especially those receiving intensive chemotherapy or autologous bone marrow transplant. However, to date, cytokine therapy has not impacted on survival rates. This is an important consideration since these agents are very costly. In an effort to direct the ration al use of these agents and to limit the cost, it will be necessary to conduct randomized pediatric studies to examine not only clinical endp oints but also the impact of cytokines on the cost of therapy.