Original report| Volume 3, ISSUE 2, P70-75, 1999

Outcomes of granulocyte colony-stimulating factor or granulocyte-macrophage colony-stimulating factor use in neutropenic patients infected with human immunodeficiency virus

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      Objective: To characterize the effects of granulocyte colony-stimulating factor (G-CSF) or granulocyte-macrophage colony-stimulating factor (GM-CSF) on clinical outcomes in neutropenic HIV-infected patients, by means of a retrospective cohort study at an urban teaching hospital.
      Method: Data were reviewed from all patients discharged between January 1, 1996, and August 31, 1997, with human immunodeficiency virus and neutropenia (absolute neutrophil count (ANC) <1000 cells/μL), with outcome measures of length of stay, infectious complications, and survival to discharge.
      Results: Of the 228 discharged patients who met selection criteria, 71 had received G-CSF or GM-CSF; 157 controls had not. Cases had lower CD4+ cell counts (30 vs. 54 cells/μL; P = 0.017) and lower nadir ANCs (372 vs. 579 cells/μL; P < 0.001). Granulocyte-CSF or GM-CSF usage was not associated with the frequency of site-related infections, fever, or sepsis (all P > 0.20). No difference was found in duration of hospitalization (23 vs. 21 days; P > 0.20). In a logistic regression model for survival to discharge, higher nadir ANC and CSF use were independently associated with improved survival (P = 0.034 and P = 0.026, respectively).
      Conclusion: Use of G-CSF or GM-CSF was associated with improved survival to discharge among hospitalized HIV-infected patients with neutropenia.



        • Murphy M.F.
        • Metcalfe P.
        • Waters A.H.
        • et al.
        Incidence and mechanism of neutropenia and thrombocytopenia in patients with human immunodeficiency virus infection.
        Br J Haematol. 1987; 66: 337-340
        • Hughes W.T.
        • Armstrong D.
        • Bodey G.P.
        • et al.
        Guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever: a statement by the Infectious Diseases Society of America.
        J Infect Dis. 1991; 162: 381-396
        • Chanock S.
        Evolving risk factors for infectious complications of cancer therapy.
        Hematol Oncol Clin North Am. 1993; 7: 771-793
        • Farber B.F.
        • Lesser M.
        • Kaplan M.H.
        • et al.
        Clinical significance of neutropenia in patients with human immunodeficiency virus infection.
        Infect Control Hosp Epidemiol. 1991; 12: 429-434
        • Whimbey E.
        • Gold J.W.M.
        • Polsky B.
        • et al.
        Bacteremia and fungemia in patients with the acquired immunodeficiency syndrome.
        Ann Intern Med. 1986; 104: 511-514
        • Hambleton J.
        • Aragon T.
        • Modin G.
        • et al.
        Outcome for hospitalized patients with fever and neutropenia who are infected with the human immunodeficiency virus.
        Clin Infect Dis. 1995; 20: 363-371
        • Moore R.D.
        • Keruly J.C.
        • Chaisson R.E.
        Neutropenia and bacterial infection in acquired immunodeficiency syndrome.
        Arch Intern Med. 1995; 155: 1965-1970
        • Shaunak S.
        • Bartlett J.A.
        Zidovudine-induced neutropenia: Are we too cautious?.
        Lancet. 1989; 2: 91-92
        • Tumbarello M.
        • Tacconelli E.
        • Caponera S.
        • et al.
        Impact of bacteremia on HIV infection: nine years' experience in a large Italian university hospital.
        J Infect. 1995; 31: 123-131
        • Lieschke G.J.
        • Burgess A.W.
        Granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor.
        N Engl J Med. 1992; 327: 99-106
        • Hartmann L.C.
        • Tschetter L.K.
        • Habermann T.M.
        • et al.
        G-CSF in severe chemotherapy induced afebrile neutropenia.
        N Engl J Med. 1997; 336: 1776-1780
        • Maher D.W.
        • Lieschke G.J.
        • Green M.
        • et al.
        Filgrastim in patients with chemotherapy-induced febrile neutropenia: a doubleblind, placebo-controlled trial.
        Ann Intern Med. 1994; 121: 492-501
        • Anaissie E.
        • Vartivarian S.
        • Bodey G.P.
        • et al.
        Randomized comparison between antibiotics alone and antibiotics plus GMCSF (Escherichia coli-derived) in cancer patients with fever and neutropenia.
        Am J Med. 1996; 100: 17-23
        • Dombret H.
        • Chastang C.
        • Fenaus P.
        • et al.
        A controlled study of recombinant human-granulocyte colony-stimulating factor in elderly patients after treatment for acute myelogenous leukemia.
        N Engl J Med. 1995; 332: 1678-1683
        • Ottmann O.G.
        • Hoelzer D.
        • Gracien E.
        • et al.
        Concomitant granulocyte colony-stimulating factor and induction chemoradiotherapy in adult acute lymphoblastic leukemia: a randomized phase III trial.
        Blood. 1995; 86: 444-450
        • American Society of Clinical Oncology
        American Society of Clinical Oncology recommendations for the use of hematopoietic colony-stimulating factors: evidence-based clinical practice guidelines.
        J Clin Oncol. 1994; 12: 2471-2508
        • American Society of Clinical Oncology
        Update of recommendations for the use of hematopoietic colony-stimulating factors: evidence-based clinical practice guidelines.
        J Clin Oncol. 1996; 14: 1957-1960
        • Hermans P.
        Clinical use of haematological growth factors in patients with human immunodeficiency virus (HIV-1) infection.
        Biomed Pharmacother. 1994; 48: 69-72
        • Miles S.A.
        The use of haematopoietic growth factors in HIV infection and AIDS-related malignancies.
        Cancer Invest. 1991; 9: 229-238
        • Kimura S.
        • Matsuda J.
        • Ikematsu S.
        • et al.
        Efficacy of recombinant G-CSF on neutropenia in patients with AIDS.
        AIDS. 1990; 4: 1251-1255
        • Kuritzkes D.
        • Parenti D.
        • Ward D.J.
        • et al.
        Filgrastim prevents severe neutropenia and reduces infective morbidity in patients with advanced HIV infection: results of a randomized, multicenter, controlled trial.
        AIDS. 1998; 12: 65-74
        • Keiser P.
        • Rademacher S.
        • Smith J.
        • et al.
        G-CSF use is associated with decreased bacteremia and increased survival in neutropenic HIV-infected patients.
        Am J Med. 1998; 104: 48-55
        • De Pauw B.E.
        • Deresinski S.C.
        • Feld R.
        • et al.
        Ceftazidime compared with piperacillin and tobramycin for the empiric treatment of fever in neutropenic patients with cancer.
        Ann Intern Med. 1994; 120: 834-944
      1. Report of the Task Force of Microbiology and Infectious Diseases. 6th ed. NIH Publication No. 92-3220. National Institute of Allergy and Infectious Diseases, Bethesda, MDApril 1992
        • Meynard J.L.
        • Guiguet M.
        • Arsac S.
        • et al.
        Frequency and risk factors of infectious complications in neutropenic patients infected with HIV.
        AIDS. 1997; 11: 955-998