期刊
CANCER
卷 106, 期 12, 页码 2664-2671出版社
WILEY
DOI: 10.1002/cncr.21929
关键词
granulocyte transfusions; invasive fungal infection; interferon gamma; colony stimulating factors; immune enhancement
类别
BACKGROUND. The response to antifungal therapy alone often is suboptimal in patients with cancer who have therapy-refractory neutropenia, and even donor-derived granulocyte transfusions (GTX) are not always successful. The authors evaluated the safety and efficacy of immune enhancement using recombinant interferon gamma 1b (rIFN-gamma 1b) in patients with cancer who received GTX for refractory, systemic, opportunistic infections. METHODS. Twenty recipients of high-dose donor GTX (approximate to 5.5 x 10(10) neutrophils per transfusion) who had received concurrent rIFN-gamma 1b between October 2001 and December 2004 were evaluated retrospectively. RESULTS. The median age (+/- standard deviation [SD]) was 45 +/- 17 years. Ten patients (50%) were men, 17 patients (85%) had leukemia, and 3 patients (15%) had myelodysplastic syndrome. The median +/- SD Acute Physiology and Chronic Health Evaluation II score was 15 +/- 4 (range, 7-22). Most patients (n = 18 patients; 90%) had recurrent or refractory cancer. In 6 patients (30%) who received allogeneic hematopoietic stem cell transplantation, GTX plus rIFN-gamma 1b was given a median +/- SD of 26 +/- 100 days (range, 12-372 days) after transplantation. Seventeen patients (85%) had neutropenia during GTX therapy. Five patients (25%) had possible invasive fungal infection, 3 patients (15%) had probable invasive fungal infection, and 11 patients (55%) had proven invasive fungal infection. One patient (5%) had refractory Pseudomonas aeruginosa sepsis. Eight patients (40%) received corticosteroids during GTX plus rIFN-gamma 1b therapy. Patients received a median +/- SD of 8 +/- 7 GTX doses (range, 4-28 doses) and 9 +/- 7 rIFN-gamma 1b doses (range, 1-28 doses), for a mean +/- SD cumulative dose (CD) of 400 +/- 2621 mu g. Other concomitant cytokines were granulocyte-colony stimulating factor (12 3 doses; CD, 6720 +/- 4721 mu g) in 15 patients (75%) and granulocyte-macrophage-colony stimulating factor (12 +/- 9 doses; CD, 4750 +/- 4410 mu g) in 14 patients (70%). Four patients (20%) developed fever, and 2 patients (10%) developed skin rashes. Reversible liver dysfunction (n = 3 patients; 15%) and tachycardia (n = 1 patients; 5%) were considered rIFN-gamma 1b-associated adverse reactions; whereas, in 1 patient (5%), transient dyspnea was attributed to GTX Four weeks after therapy started, 9 patients (45%) had complete or partial resolution of infection; and, in another 3 patients (15%), the invasive fungal infection had become stable. CONCLUSIONS. The current results indicated that no serious adverse events were associated with rIFN-gamma 1b immune enhancement in patients with systemic opportunistic infections who received donor GTX therapy.
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