Colony-stimulating factors for prevention of myelosuppressive therapy-induced febrile neutropenia in children with acute lymphoblastic leukaemia

Sasse, Emma Chen; Sasse, André Deeke; Brandalise, Sílvia Regina; Clark, Otávio; Richards, Sue

doi:10.1002/14651858.cd004139.pub2

Cited by 27 publications

(21 citation statements)

References 68 publications

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“…Filgrastin, a colony-stimulating factor, was used in this case as means to decrease the duration of clozapineinduced neutropenia. Its presumed efficacy is based on case reports [19][20] and studies in cancer patients under cytotoxic chemotherapy [21]. Given that protective mechanical ventilation and appropriate restoration of tissue through fluid challenge and vasopressor are two measures associated with better outcomes in critically ill patients, they likely played important roles in the positive outcome reported here [18].…”

Section: Discussionmentioning

confidence: 98%

Managing clozapine-induced neutropenic fever: A case report

Rosa¹,

Rosa²,

Barros³

2015

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Clozapine is an atypical antipsychotic, which is associated with an increased risk of neutropenia. Given that the signs and symptoms of infection in neutropenic patients are often subtle or absent because of the lack of an appropriate inflammatory response, fever may constitute the sole indicator of a serious underlying infection. Unfortunately, data about management of patients with neutropenic fever secondary to clozapine are scarce. Consequently, the entire management of this syndrome is based on extrapolation of data from the experience with cancer patients with neutropenia secondary to cytotoxic chemotherapy. Case Report: Herein, we describe the management of a neutropenic fever case complicated with septic shock and acute respiratory failure in an 57-year-old Caucasian female with the diagnosis of schizophrenia and type-2 diabetes mellitus, who was being treated with clozapine. The patient rapidly developed cardiorespiratory collapse requiring mechanical ventilation and vasoactive drugs few minutes after arrival at hospital. Profound neutropenia (absolute neutrophil count 60 cells/mm3) and lobar pneumonia were diagnosed. Broad-spectrum antimicrobial therapy with piperacillin-tazobactam plus vancomycin and supportive intensive care were promptly implemented. The clozapine-induced neutropenia was managed with filgrastim. Pseudomonas aeruginosa was isolated from the tracheal aspirate and blood cultures. After a total length of hospital stay of 44 days, the patient was discharged home. Conclusion: Neutropenic fever is a serious complication of clozapine treatment. Prompt administration of empiric broad-spectrum antibiotics and supportive care are required to avoid the high levels of mortality associated with this syndrome.

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Section: Discussionmentioning

confidence: 98%

Managing clozapine-induced neutropenic fever: A case report

Rosa¹,

Rosa²,

Barros³

2015

IJCRI

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“…G-CSF has been also given to AML patients to shorten febrile neutropenia period after induction therapy [7,20]. In childhood ALL the use of G-CSF has become widespread to shorten febrile neutropenic period, since under physiological circumstances G-CSF does not have any influence on the proliferation/differentiation pathways in lymphoid lineage, therefore it is thought that G-CSF has no effect on ALL blasts [4].…”

Section: Discussionmentioning

confidence: 99%

“…At the same time stimulatory effects of G-CSF on leukaemic lymphoblasts are unexpected, since according to our current knowledge it does not have any influence on pathways of proliferation and differentiation in the lymphoid lineage [21]. Although, the effects of these GFs at a cellular level are not well understood, the clinical use of G-CSF to minimize chemotherapy-induced myelosuppression in childhood ALL has become more widespread [4,22].…”

Section: Introductionmentioning

confidence: 94%

“…Febrile neutropenia is a potentially life threatening side effect of the current chemotherapy [4]. Several clinical trials have attempted to evaluate the effect of colony-stimulating factors (CSF) in shortening the period with neutropenia and preventing febrile period in children with solid tumors, ALL and with some types of AML but in acute leukaemia they failed to provide any evidence supporting the benefit of growth factors (GFs) for the patients' overall survival [4][5][6][7]. Haemopoietic progenitor stem cells require specific growth signals to ensure the proper balance of proliferation and differentiation.…”

Section: Introductionmentioning

confidence: 99%

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Granulocyte Colony Stimulating Factor Increases Drug Resistance of Leukaemic Blast Cells to Daunorubicin

Márkász

Hajas

Kiss

et al. 2008

Pathol. Oncol. Res.

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Acute leukaemia is known as the most common cancer in childhood. Febrile neutropenia is a common serious side effect of the cytostatic treatment of malignancies. The clinical use of Granulocyte Colony Stimulating Factor (G-CSF) has become widespread to minimize chemotherapy-induced myelosuppression and febrile neutropenia in childhood solid tumors, acute lymphoid leukaemia (ALL) and in several trials with AML. In case of ALL this seems to be reasonable because, due to the absence of G-CSF receptor (G-CSFR) on the surface of normal lymphoid cells, G-CSF does not have any influence on the pathways of proliferation and differentiation of lymphoid lineage cells. It has been suggested, however, that ALL blasts with B or T cell surface antigens as well as biphenotypic leukaemia cells express G-CSFR, and they are able to respond to exogenously added G-CSF with proliferation. In this study we investigated how G-CSF might influence the sensitivity of leukemic cells to daunorubicin induced cell death using MTT assay, flow cytometry and Western blot analysis. After pretreatment of KG-1 leukaemic cells with G-CSF a moderate increase in the resistance of these cells to daunorubicin could be observed. These results draw attention to the risk of G-CSF application as an adjuvant therapy of childhood ALL. In addition, adjuvant treatment of AML patients with G-CSF in order to prevent neutropenia, or its use in priming regimens might result resistance to daunorubicin.

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“…Thus, a systematic review on the use of colony-stimulating factors in patients with hematologic malignancies will be a far greater undertaking than a systematic review of colony-stimulating factors in preventing chemotherapy-induced febrile neutropenia in children with acute lymphoblastic leukemia. 10 When reading a systematic review one must always ascertain that the investigators are answering the question originally posed. A major cause of bias in a systematic review is answering a different question to that originally asked.…”

Section: The Clinical Questionmentioning

confidence: 99%

Systematic review and meta-analysis methodology

Crowther

Lim

2010

Blood

228

168

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Systematic reviews and meta-analyses are being increasingly used to summarize medical literature and identify areas in which research is needed. Systematic reviews limit bias with the use of a reproducible scientific process to search the literature and evaluate the quality of the individual studies. If possible the results are statistically combined into a meta-analysis in which the data are weighted and pooled to produce an estimate of effect. This article aims to provide the reader with a practical overview of systematic review and meta-analysis methodology , with a focus on the process of performing a review and the related issues at each step. (Blood. 2010;116(17): 3140-3146)

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Colony-stimulating factors for prevention of myelosuppressive therapy-induced febrile neutropenia in children with acute lymphoblastic leukaemia

Cited by 27 publications

References 68 publications

Managing clozapine-induced neutropenic fever: A case report

Managing clozapine-induced neutropenic fever: A case report

Granulocyte Colony Stimulating Factor Increases Drug Resistance of Leukaemic Blast Cells to Daunorubicin

Systematic review and meta-analysis methodology

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