Monocyte deactivation and its reversal in a patient with chemotherapy-induced leukopenia and severe systemic infection

Background. Serious infections constitute a major problem for patients with cancer, and new approaches must be found in dealing with these. The pathop hysiology of neutropenic infection is not well understood, although there i s some evidence that, as in sepsis in the primarily immunocompetent host, a pro- and an anti-inflammatory phase can be discriminated. In the recent li terature is described a series of nonneutropenic patients with sepsis in wh om interferon-gamma was successfully administered during the immunoparalyti c phase, a concept that might possibly be extended to immunocompromised hos ts. Procedure. A 14-year-old patient with RAEB-T/hypoplastic M2 and chemoth erapy-induced neutropenia developed a severe infection and continued to det eriorate clinically despite maximum supportive measures, including broad an tibacterial and antifungal coverage. On the basis of monocyte de-activation this patient was considered to be in the immunoparalytic phase of sepsis a nd consequently treated with 60 mu g/m(2) of interferon-gamma per day for 1 0 days. Results. The patient made a rapid clinical recovery, and biochemica l markers of infection improved promptly. At the same time, the fraction of activated monocytes normalized rapidly and stably. We hypothesize that tre atment with interferon-gamma effected this rapid restoral of monocyte activ ation and that monocyte reactivation might have contributed to the patient' s prompt recovery from his severe infection. Interferon-gamma treatment was well tolerated. Conclusions. Immunostimulation with interferon-gamma might prove to be a valuable adjuvant treatment for patients with chemotherapy-i nduced neutropenia during the rare scenario of infection with immunoparalys is. Med. Pediatr. (C) 2000 Wiley-Liss, Inc.