Current Issues In The Management Of Neutropenia And Infections In Patients With Cancer

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As outlined in this chapter, the availability of rHuG-CSF has had profound medical and scientific implications. The ability of rHuG-CSF to accelerate bone marrow recovery has greatly altered the approach to chemotherapy and management of neutropenia risk in patients with cancer. The availability of rHuG-CSF has stimulated interest in understanding the physiology and regulation of neutrophil production, as well as other ways to enhance host resistance to bacterial infections. The availability of rHuG-CSF has also stimulated interest in defining host responses to cancer chemotherapy and specific factors (i.e., cellular components, cytokines, environmental factors, bone marrow recovery rate).It is relatively easy to measure the blood neutrophil counts, but cancer chemotherapy and the HGFs exert most of their effects on hematopoietic cells in the bone marrow. Better information is needed about the kinetics of recovery of primitive hematopoietic cells and their progeny in the bone marrow to guide the use of HGFs for patients receiving cancer chemotherapy. Although several new antifungal agents have recently become available, development of new antibiotics has slowed remarkably. The promise for the next decade is better supportive care through minimizing the toxicities of cancer treatments and better understanding of how to augment host defense mechanisms.

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