Antifungal effects of yeast-derived rhu-GM-CSF in patients receiving high-dose chemotherapy given with or without autologous stem cell transplantation: A retrospective analysis

B. G. Peters, D. R. Adkins, B. R. Harrison, W. S. Velasquez, F. R. Dunphy, P. J. Petruska, C. E. Bowers, R. Niemeyer, W. McIntyre, D. Vrahnos, S. E. Auberry, G. Spitzer

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Abstract

Systemic fungal infections (SFI) in patients receiving high-dose chemotherapy (HDC) are a frequent cause of morbidity and mortality. Preclinical studies have reported augmented antifungal activity of monocytes, macrophage cells, and neutrophils exposed to certain colony-stimulating factors (CSF), including GM-CSF. We conducted a retrospective descriptive epidemiologic study to examine the characteristics of 145 consecutive patients receiving HDC administered with or without autologous stem cell transplantation (ASCT) and who subsequently received either GM-CSF and G-CSF, G-CSF alone, GM-CSF ± IL-3 or no CSF. The analysis of this patient population sought to define the incidence of SFI and its relationship to therapy with monocyte/macrophage-stimulating (MMS group) cytokines (GM-CSF and G-CSF; GM-CSF ± IL-3) or to cytokines which do not result in monocyte/macrophage stimulation (NMMS group, G-CSF alone or no CSF). Risk factors for the development of SFI were balanced between the MMS (n = 70) and NMMS (n = 75) groups. Two patients (2.9%) in the MMS and nine patients (12%) in the NMMS groups developed SFI. The risk ratio for developing SFI in the NMMS group compared to the MMS group was 4.20 (P = 0.023). This relationship was confounded, however, by the diagnosis of hematologic tumor or solid tumor (RR = 3.15, P = 0.082). SFI was the primary cause or major contributing factor in five of the 10 total deaths in our study population. Four SFI-related deaths occurred in the NMMS group and one SFI-related death occurred in the MMS group. Our data suggest a protective role for GM-CSF, IL-3 or other MMS cytokines in preventing SFI in patients receiving HDC. This should be further investigated as a potential complementary approach to conventional strategies in antifungal prophylaxis for patients receiving HDC.

Original languageEnglish
Pages (from-to)93-102
Number of pages10
JournalBone Marrow Transplantation
Volume18
Issue number1
StatePublished - Jul 1 1996

Keywords

  • Antifungal agents
  • Autologous transplantation
  • GM-CSF
  • High-dose therapy

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    Peters, B. G., Adkins, D. R., Harrison, B. R., Velasquez, W. S., Dunphy, F. R., Petruska, P. J., Bowers, C. E., Niemeyer, R., McIntyre, W., Vrahnos, D., Auberry, S. E., & Spitzer, G. (1996). Antifungal effects of yeast-derived rhu-GM-CSF in patients receiving high-dose chemotherapy given with or without autologous stem cell transplantation: A retrospective analysis. Bone Marrow Transplantation, 18(1), 93-102.