The Effectiveness of Granulocyte Colony- Stimulating Factor in Remission of Chemotherapy-Induced Febrile Neutropenia, Fever and Hospitalization Period in ALL Pediatric Patients

Chemotherapy-induced neutropenia is a life threatening and common side effect in treatment of acute lemphoblastic leukemia (ALL). It predisposes to serious infections, fever and prolonged hospitalization. The aim of the present study was to assess the effectiveness of G-CSF in combination with antibiotics in shortening the periods of hospitalization, fever and chemotherapy-induced neutropenia Subjects and The was prospective randomized clinical study carried out on 140 patients with acute lymphoblastic leukemia (ALL) who received a standard intensification dose with prednisolon, adriamycin, cytosar, MTX, 6TG and VCR. These patients were referred to our pediatric ward of Shafa hospital, Ahwaz University of Medical Sciences, over three years (2001 to 2003) due to (fever >38°C), neutropenia (ANC<500/mm3) and with no obvious sings of infection (pneumonia, sepsis or diarrhea). A random group of 68 patients were assigned to receive G-CSF (10 g/Kg/day) for at least 3 days with a combination of antibiotic and 72 patient received only standard antibiotic therapy. When the patients became afebrile with ANC>1500 were discharged from hospital Patients randomized to G-CSF had a shorter hospitalization (median 7.6.v 8.8 days; p<0.001), and shortening of neutropenia period (median 6.7 v 8.0 days p<0.001). However, difference in the period of fever between both groups was observed (mean 3.2 days). G-CSF treated patients also had more rapid neutrophil recovery and higher neutrophil levels at the time of discharge (1600 v 2020 ANC, p<0.001) Adding G-CSF therapy to antibiotic treatment shortens the duration of neutropenia and hospitalization periods in the patients with fever and neutropenia. However, this combination had no effect on the mortality rate and duration of fever. Larger studies on the cost effectiveness of this trial needs to be assessed independently.