Granulocytopenia and cancer therapy: Past problems, current solutions, future challenges

Abstract

Granulocytopenia has been closely associated with cancer and its treatment. The risk for a life‐threatening infection when the granulocyte count falls below 500/mm3 not only is an important complication of therapy and a major cause of death in cancer patients but also plays an important role in the design, schedule, and doses of cancer treatment regimens. While granulocytopenia remains an unavoidable complication of current therapy, improved recognition of patients at risk and prompt initiation of aggressive supportive care have had a significant impact on reducing its infection‐related morbidity and mortality. In particular, early empiric antibiotic therapy when the granulocytopenic patient becomes febrile has resulted in a significant reduction in the early mortality from undiagnosed bacterial infections. New antibiotics (extended‐spectrum penicillins, third generation cephaloporins) provide new options because of their broad efficacy and potential for reducing the toxicity of antimicrobial therapy. However, as bacterial infections have become better controlled, fungi have emerged as important pathogens. Early aggressive empiric antifungal therapy appears to have reduced infectious mortality, although the repertoire of effective antifungal agents is quite limited. Considerable efforts have been expended in trying to replenish graulocytes by transfusion in infected patients, but technical deficiencies have limited this approach. Current and future efforts are directed toward refining management as well as to developing methods to improve host defenses and provide prophylaxis against infections. If the full potential of current cancer therapy is to be realized, control of granulocytopenia and the prevention of infections are essential goals.

Effector Mechanisms of Recombinant IgA Antibodies against Epidermal Growth Factor Receptor

“…After binding to the polymeric Ig receptor, IgA dimers are actively transported to luminal surfaces, where IgA has an important function in the homeostasis of immune functions (16). Upon inflammatory stimuli, neutrophils gain rapid access to serosal surfaces, where they play a predominant role in the primary host defense against invading bacteria (30). Studies with cytokine-transfected tumor cells also suggested a significant contribution of neutrophils in tumor surveillance (31), but these observations await confirmation in more clinically relevant settings.…”

Was muss ich praktisch bei der Umsetzung einer Chemotherapie beachten?

“…Chemotherapy · Emesis · Quality of life · Side-effects · Application Durch die Untersuchungen von Pizzo [14] konnte gezeigt werden, dass der Grad der Granulozytopenie mit Auftreten schwerer infektiöser Komplikationen korreliert. Eine Granulozytopenie von weniger als 1000/mm 3 verursacht bei 12 der Patienten eine fieberhafte Infektion.…”

Economic evaluation of cancer treatments

“…In particular the severity and duration of neutropenia determines the risk of infection and the outcome of the patient (Bodey et al, 1966;Pizzo, 1984). Recently, different haematopoietic growth factors (HGFs) have been produced which has given the opportunity to modulate the period of granulocytopenia.…”

“…The risk of a life-threatening infection increases significantly when the neutrophil count falls below O.5xlO'/l and it is a major cause of death in cancer patients. Furthermore, the duration of neutropenia has an important role in the design, schedule, and dose of cancer treatment regimens (Ant man et al, '1988;Pizzo, 1984). Treatment-related neutropenia is highly variable, ranging from days to weeks.…”