Improving treatment of chemotherapy-induced XXXX by administration of colony-stimulating factors.

@entity1 @entity2841 @entity5505 @entity1261 @entity5 @entity4509 @entity1398 @entity236 @entity221
BACKGROUND: Several randomized trials have tested the use of @entity1261 ( @entity1261 ) and @entity2841 ( @entity2841 ) in relieving chemotherapy-induced @entity236 . However, the use of CSFs in the treatment of @entity221 remains virtually unexplored. PURPOSE: This study evaluated the benefits of adding CSF therapy to the standard antibiotic treatments given to @entity5 @entity1 for chemotherapy-induced @entity221 . The usefulness of CSFs was quantified in terms of reducing the following: (a) the duration of @entity1398 , (b) the length of hospitalization, and (c) the overall cost of the treatment. METHODS: A randomized trial was conducted to test whether the administration of either @entity1261 or @entity2841 improved the outcome of standard antibiotic therapy ( @entity5505 plus @entity4509 ) in nonleukemic @entity5 @entity1 with @entity221 (> 38 degrees C) and grade IV @entity1398 (absolute neutrophil count [ANC] < 500/mm3) induced by standard-dose chemotherapy. Of 121 @entity1 who entered the trial, 39 received @entity1261 (5 micrograms/kg body weight per day), 39 received @entity2841 (5 micrograms/kg body weight per day), and 43 received a placebo beginning just after the first dose of antibiotics. Treatments were continued for at least 5 days (7 days with clinically or microbiologically documented infections) or until 2 days after @entity221 subsided and ANCs rose above 1000/mm3. RESULTS: The median duration of grade IV @entity1398 (ANC of < 500/mm3) was 2 days in both CSF arms and 3 days in the placebo arm (P < .001). The median duration of @entity1398 with an ANC of less than 1000/mm3 was also significantly shorter in @entity1 receiving @entity1261 or @entity2841 (P < .001). The median duration of @entity221 was similar in the three arms. The median hospital stay was 5 days (range, 5-14 days) in the @entity1261 arm, 5 days (range, 5-10 days) in the @entity2841 arm, and 7 days (range, 5-34 days) in the placebo arm (P < .001). The median time on CSF was 4 days in both treatment arms. The mean cost of overall treatment was reduced by  1300- 1400 in the CSF arms compared with the placebo arm (P = .11 for @entity1261 versus placebo; P = .06 for @entity2841 versus placebo; P = .7 for @entity1261 versus @entity2841 ). CONCLUSIONS: Adding @entity1261 or @entity2841 therapy to antibiotic treatment shortens the duration of @entity1398 and the duration of hospitalization in @entity1 with @entity221 . A statistically nonsignificant trend toward lower cost was observed in the CSF arms as compared with the placebo arm. IMPLICATIONS: The benefits of CSFs to @entity5 @entity1 with chemotherapy-induced @entity221 merit further evaluation in large randomized trials.
