GRANULOCYTE-COLONY-STIMULATING FACTOR IN SEVERE CHEMOTHERAPY-INDUCED AFEBRILE NEUTROPENIA

Background Randomized trials of colony-stimulating factors in febrile patients with neutropenia after chemotherapy have not consistently sho wn clinical benefit. Nevertheless, the use of colony-stimulating facto rs to treat patients with chemotherapy-induced neutropenia is widespre ad. Methods We performed a randomized, double-blind, placebo-controlle d trial of granulocyte colony-stimulating factor (G-CSF) in afebrile o utpatients with severe chemotherapy-induced neutropenia. We measured t he number of days of neutropenia, rate of hospitalization, number of d ays in the hospital, number of days the patient received parenteral an tibiotics, and number of culture-positive infections. Results We rando mly assigned 138 patients to receive G-CSF (n=71) or placebo (n=67). T he median time to an absolute neutrophil count higher than 500 per cub ic millimeter was significantly shorter for patients who received G-CS F (two days, vs. four days for the patients given placebo). However, t here was no effect on the rate of hospitalization, number of days in t he hospital, duration of treatment with parenteral antibiotics, or num ber of culture-positive infections. Conclusions Routine therapeutic ap plication of G-CSF in afebrile patients with severe neutropenia can re duce the duration of neutropenia, but this does not appear to provide practical clinical benefit. (C)1997, Massachusetts Medical Society.