ROLE OF GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR AS ADJUVANT TREATMENT IN NEUTROPENIC PATIENTS WITH BACTERIAL AND FUNGAL INFECTION

The results are presented of two preliminary studies conducted to asse ss the role of GM-CSF as adjuvant treatment in neutropenic patients wi th bacterial or fungal infections. In the first study the effect of GM -CSF on the rate of response to antibiotics was assessed. Febrile neut ropenic patients (n = 91) were randomized to receive ticarcillin-clavu lanate plus netilmicin with or without GM-CSF (60 mu g/m(2)). Response rates were significantly higher in patients who received antibiotics plus GM-CSF (p = 0.05). An increase in neutrophil count was seen in 89 % of GM-CSF patients with initial low neutrophil counts (< 100/mu l) compared with 67 % of control patients (p = 0.04). In the second study the activity of GM-CSF in patients with fungal infections was assesse d. Neutropenic patients with documented fungal infections received amp hotericin B plus GM-CSE. Of the eight evaluable patients, six responde d and four had a complete response to treatment. The neutrophil counts of the two non-responding patients did not increase substantially dur ing GM-CSF treatment and both died of their fungal infection. The prog nosis of neutropenic patients with fungal infections is usually poor a nd the results of this pilot study are therefore very encouraging. The two studies show that GM-CSF is able to stimulate neutrophil recovery in neutropenic patients and may improve the response to antibiotic an d antifungal treatment.