Growth Factors and Empiric Therapy with Antibiotics: Should They Be Used Concurrently?

l w o colony-stimulating factors—or hematopoietic growth factors—are commercially available: human recombinant granulocyte colony-stimulating factor (G-CSF) and granu-locyte-macrophage colony-stimulating factor (GM-CSF). These compounds are used frequently by oncologists to reduce the nadir of chemotherapy-induced neutropenia or hasten the recovery of normal neutrophil counts after chemotherapy in the hope that infection will not develop or that febrile neutropenia will quickly resolve. Based on current knowledge, what should be the rational use of these cytokines? Aggressive chemotherapy with or without total body radiation leads to leukopenia, among other side effects. Infection is the major consequence of neutropenia. Infec-tion incidence and severity have an inverse relation to th