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Annals of Oncology 6:371-375, 1995
© 1995 European Society for Medical Oncology

research-article

Neutropenic fever following cladribine therapy for symptomatic hairy-cell leukemia: Predictive factors and effects of granulocyte-macrophage colony-stimulating factor

G. Juliusson1,3,, R. Lenkei5, G. Tjønnfjord2,6, D. Heldal2 and J. Liliemark4

1Departments of Medicine, Huddinge Hospital Huddinge Sweden
2The National Hospital Oslo, Norway
3Department of Hematology, Linköping Hospital
4Departments of Oncology and Clinical Pharmacology, Karolinska Hospital, Karolinska Institute
5SBL Calab Diagnostics Stockholm, Sweden
6The Institute of Transplantation Immunology Oslo, Norway

Correspondence to: Dr. Gunnar Juliusson, Department of Hematology, University Hospital, S-581 85 Linkoping, Sweden

BACKGROUND: Neutropenic fever is the commonest complication of cladribine therapy for hairy-cell leukemia (HCL), leading to a 3% mortality rate. Our aim was to identify predictive factors and evaluate the effects of concomitant granulocyte-macrophage colony-stimulating factor (GM-CSF).

PATIENTS AND METHODS: We studied 102 patients with active HCL given cladribine for 7 days. Pretreatment parameters predicting neutropenic fever were analysed. Twelve patients at high risk for febrile complications also received 400 (ig GM-CSF per day on days 1 through 21.

RESULTS: Pretreatment anemia, hypocholesterolemia, bone marrow differential with a high percentage of hairy cells and a low percentage of myelopoietic cells, low albumin, and high C-reactive protein predicted neutropenic fever. The addition of GM-CSF did not improve the kinetics of recovery for neutrophils, hemoglobin or platelets, as compared to matched control patients. However, GM-CSF significantly reduced cladribine-induced lymphopenia, but not the incidence of neutropenic fever.

CONCLUSION: Factors predicting febrile neutropenia were identified. GM-CSF protected from cladribine lymphotoxic-ity but did not improve neutropenia or febrile episodes

2-chlorodeoxyadenosine, CdA, cladribine, GMCSF, infections, T-lymphocyte subsets, hairy-cell leukemia


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