Document Detail


Recombinant interferon gamma1b immune enhancement in 20 patients with hematologic malignancies and systemic opportunistic infections treated with donor granulocyte transfusions.
MedLine Citation:
PMID:  16691620     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 gamma1b (rIFN-gamma1b) in patients with cancer who received GTX for refractory, systemic, opportunistic infections. METHODS: Twenty recipients of high-dose donor GTX ( approximately 5.5 x 10(10) neutrophils per transfusion) who had received concurrent rIFN-gamma1b 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-gamma1b 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-gamma1b therapy. Patients received a median +/- SD of 8 +/- 7 GTX doses (range, 4-28 doses) and 9 +/- 7 rIFN-gamma1b doses (range, 1-28 doses), for a mean +/- SD cumulative dose (CD) of 400 +/- 2621 microg. Other concomitant cytokines were granulocyte-colony stimulating factor (12 +/- 3 doses; CD, 6720 +/- 4721 microg) in 15 patients (75%) and granulocyte-macrophage-colony stimulating factor (12 +/- 9 doses; CD, 4750 +/- 4410 microg) 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-gamma1b-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-gamma1b immune enhancement in patients with systemic opportunistic infections who received donor GTX therapy.
Authors:
Amar Safdar; Gilhen H Rodriguez; Benjamin Lichtiger; Burton F Dickey; Dimitrios P Kontoyiannis; Emil J Freireich; Elizabeth J Shpall; Issam I Raad; Hagop M Kantarjian; Richard E Champlin
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cancer     Volume:  106     ISSN:  0008-543X     ISO Abbreviation:  Cancer     Publication Date:  2006 Jun 
Date Detail:
Created Date:  2006-06-07     Completed Date:  2006-07-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0374236     Medline TA:  Cancer     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2664-71     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2006 American Cancer Society.
Affiliation:
Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. asafdar@mdanderson.org
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / therapeutic use
Adult
Aged
Antifungal Agents / adverse effects,  immunology*,  therapeutic use*
Child
Combined Modality Therapy
Cytokines / therapeutic use
Dose-Response Relationship, Drug
Drug Resistance, Neoplasm
Drug Therapy, Combination
Female
Gram-Negative Bacterial Infections / complications,  drug therapy,  mortality
Granulocytes / transplantation*
Hematologic Neoplasms / complications*,  therapy
Humans
Interferon-gamma, Recombinant / adverse effects,  immunology*,  therapeutic use*
Leukocyte Transfusion*
Male
Middle Aged
Mycoses / complications,  drug therapy*,  mortality
Neutropenia / etiology
Opportunistic Infections / complications,  drug therapy*
Recombinant Proteins / adverse effects,  therapeutic use*
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Antifungal Agents; 0/Cytokines; 0/Interferon-gamma, Recombinant; 0/Recombinant Proteins

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