Haematopoietic Growth Factors in Children With Neutropenia

The approach to the treatment of a patient with a decreased number of circulating neutrophils has been based primarily on the experience in cancer patients (Pizzo, 1993). Over the past three decades, the supportive care paradigm has evolved into a highly sophisticated process that requires constant attention and a readiness to respond to rapid changes, many of which have been induced by previous interventions. The principles are readily applicable to other patients with neutropenia (e.g. congenital), but it may not be necessary to intervene in this group, especially if there are no other defects in host defence. In contrast, therapy-induced alterations of the immune system other than neutropenia, such as alterations in skin/mucosal barriers and defects in cell-mediated and humoral immunity, increase the predisposition to infection in cancer patients (Lehrnbecher et al, 1997). The clinical significance of these alterations is not clear and is the focus of ongoing studies. Early studies in cancer patients demonstrated the increased likelihood that a serious bacterial infection would occur during absolute neutropenia, which is defined as an absolute neutrophil count (ANC) of less than 0·5 × 109/l (Bodey et al, 1966; Schimpff et al, 1971, 1972). Not only the depth but also the duration of neutropenia contributes to the risk for infection; for example, it was observed that the likelihood of developing a bacterial infection approached 100% when patients remained neutropenic for 3 or (Bodey et al, 1966; Schimpff et al, 1971, 1972). was that the of than with serious infection in the neutropenic In to the observed in the of these has evolved and which is et al, et al, The of this approach has been based on clinical the of the are in the neutropenic host is the for of as as of the for (Pizzo, 1993). of the and of is the of which The of and has supportive care in the neutropenic cancer patient et al, et al, et al, and circulating of neutrophils by and of et al, et al, also of and in the clinical of this are not readily et al, the of the of and and have been of which clinical for In this the are and be in but not clinical The that and in the has for for and In and in neutrophils et al, 1997). also in a to neutrophils et al, et al, In and and and et al, et al, 1997). has been to and of bacterial and et al, et al, and increase of has and neutrophils with et al, and have and are for in the of the of these is not as defined and is the of ongoing clinical have been in the of et al, and in et al, but these the of in has been to patients et al, The focus of this is to the on clinical of in patients and in clinical as The of the and has been in in cancer but the of has been in studies with and neutropenic but it has been demonstrated that and the duration of neutropenia and the of neutropenia et al, et al, et al, et al, et al, et al, et al, et al, et al, et al, et al, et al, et al, et al, et al, et al, et al, et al, the clinical of neutropenia have not into a of risk for the the have been an of such as of and duration of The of in a of or of a of but the of neutropenia in studies in a of with et al, et al, 1997). the of neutropenic to et al, and the of to et al, and to et al, 1997). In the duration of during was to patient et al, and the was to et al, 1997). also observed in in with with and the of et al, et al, other studies not a clinical of or in patients with et al, et al, et al, was that may be in with neutropenia of duration in to with of and neutropenia et al, is by a in which was to with and to with et al, In the a of not the duration of neutropenia of in the the duration of neutropenia was by to et al, in a in with and the of patients treatment and et al, this was not in with to and patients with risk with risk and with risk et al, In a in with or the of and et al, patients of the of and of the patients was in patients with as of for the and have the to of in et al, et al, et al, 1993). clinical studies in patients have not of when of to the for the of by the of of be of in et al, of the in patients are necessary be the of for patients with with patients with and patients with the of in with a is less In a of as an to in patients with a of duration of neutropenia was observed in 3 and and and et al, no was in clinical such as the of neutropenic or the duration of for et al, and et al, et al, et al, et al, et al, in with or studies are to the of the of for these In the of be of et al, et al, The of or be for patients with an of neutropenia such as for or of et al, et al, of and be by to these to increase of number of have the of with the of a in patients on the of in to of or to the et al, et al, et al, et al, may with (e.g. or has such as or the of with may be et al, et al, et al, example, in a in with or a increase of of and was by and supportive other than et al, that with treatment be by et al, other have not a et al, et al, et al, In and not therapy-induced alterations of the host other than example, for cancer have defects in cell-mediated et al, et al, and such defects in clinical et al, et al, In a and for of of patients in this such as and et al, that of the with be but the of was that of to the for of the of in patients with observed that less treatment in the with a in in the than in the et al, these have not been in other The of or of less and not the of the in studies et al, et al, et al, no in of treatment was et al, et al, et al, et al, In there is no for the of to increase or or a clinical in which the of the of in this clinical is et al, as has or of neutropenic in or with a in an of are a of in for cancer et al, In this the treatment of patients with neutropenia in was and these patients in of The patients to during but during a duration of neutropenia in in and also a of neutropenia In contrast, the neutrophil of patients to during was to the during as as the of of that of as the risk of of neutropenia in to an of and is for have previous of or neutropenia with bacterial or infection which to of or previous of and neutropenia with or infection et al, and are only the of in neutropenia induced by the of the of and in patients with et al, of and with in et al, The of increased the by of the 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not clear a of a et al, et al, In contrast, in a in with of and the duration of neutropenia and the of neutrophil to in the et al, there no in other clinical such as the duration of and be or but it was that the may be and less and is by et al, et al, of the the of the be et al, of or the of et al, into the a of and is or other with a et al, in duration of neutropenia, the of neutropenic or duration of was observed in a in with cancer the of on or on et al, that the of be the absolute neutrophil count × 109/l and × 109/l et al, et al, of and be and of and of the clinical have been for and many studies patient or et al, 1997). the of and a of to with neutropenia to et al, patients or was observed the of infection and the duration of a for and which was to be as a of the of on and et al, et al, in the of in neutropenic cancer of is et al, not in neutropenic was in clinical in et al, et al, et al, and cancer patients et al, et al, the other in a in cancer patients with a of of and neutropenia, the of in a rapid neutrophil and a et al, 1997). by et for in a with with of neutropenia and in a of neutropenic cancer patients with et al, the in of no has that the of in cancer patients with neutropenia decreased the of that three of neutropenic patients the of with with of and or infection et al, 1997). the are based on and have to be in clinical in neutropenic patients with The the of in neutropenic with is to studies or are to of the of patients in with an infection on a of a in neutropenic cancer that the of the not to or of neutropenic patients with et al, in a of in with of neutropenia et al, of a in neutropenic cancer patients with that the of to a of the neutrophil count by but not to a of the number of or the duration of et al, that be in neutropenic or patients with (Bodey et al, et al, et al, et al, example, with or has been with in patients with with or a (Bodey et al, 1993). clinical in cancer patients that of patients to treatment with or with of patients to et al, In or the duration in a of patient be et al, In the of is not for neutropenic patients or neutropenic patients with a infection et al, et al, neutropenic patients may have that are of clinical such as or In these the of in to may be the of these have not been demonstrated et al, et al, of or are especially risk for infection during the of by and was that and would the of infection by of in patients a studies have been in et al, et al, et al, et al, et al, In studies et al, et al, the duration of neutropenia to In the clinical of in for a of the patients a of or the neutrophil count was than × 109/l et al, patients with a of not The of the the number of the duration of treatment and the of et al, in a by et In this in was a of and the number of with neutropenic and on by and and et al, In contrast, in studies with a of the of neutropenia, but not in less less on or less in et al, et al, In of the studies or a that the of a of to with in a and than in a of not et al, these have not been in other studies. 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neutropenia of the of the neutrophil patients to treatment or a by et al, 1993). or neutropenia patients with was with a and et al, 1993). patients a than × decreased with an in the and duration of and in duration of et al, 1993). patients with with in the studies on the treatment a to was et al, of these patients for as as and a to was in patients with neutropenia and in with In a in the of and the for was et al, the of the in on patients with neutropenia have been to treatment and in these patients et al, In clinical than of these patients to treatment with an increase in × 109/l et al, patients to 3 and et al, patients and of In of patients with neutropenia et al, has not been in patients with neutropenia or neutropenia et al, than of the patients to in the for the in a of the that is for et al, et al, et al, et al, to in neutropenic patients was also with or such as or et al, et al, 1997). than of the patients in the or of in et al, the of it been that in patients with neutropenia, 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the to neutrophil such as of and neutrophils and of neutrophil in to infection et al, 1993). neutrophil such as and Early in studies that the of neutrophils et al, In of in a with and during in et al, on these the of was in the in clinical in the of in have been in the of by neutrophil and et al, et al, et al, the of in et al, of of the there was a increase in the circulating which for of et al, In the a of neutrophils by the the of of in less than et al, to a of for the of or to a neutropenia in with and during a et al, was observed that than but the not in a in et al, was a of for the of and other for et al, the absolute neutrophil but the of infection not the treatment or with but of these patients has not been in the of in with of to with have neutropenia and are increased risk of and et al, et al, the of on circulating neutrophil in a of neutropenic of with et al, et al, was a of when absolute neutropenia than of neutrophil in of the patients et al, et al, neutrophil and the of in patients with neutropenia with a of for 3 with also neutropenia but not the In this increased the and the of patients in the patients not In of the was by the of the in also in with or et al, et al, et al, et al, et al, et al, et al, of with bacterial to or of or on and et al, induced a increase in the neutrophil count which was for as as the that may of neutrophils by an increase of et al, on of these patients not or et al, et the of to with and neutropenia × In this patients a of for with with to an increase in absolute neutrophil count in of with there in the et al, 1997). in a 1997). for 3 was to neutropenic and the of these was with patients in the and in the to the of the of 1997). 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