Neutropenic
fever has been one of the most difficult complications in the recovery period following high-dose
chemotherapy and autologous haematopoietic progenitor cell
transplantation. The differentiation between human recombinant
GM-CSF (
sargramostim)-related
fever and active
infection can be difficult during this observation time. In 7 of 17 patients treated for metastatic
breast cancer with HDCT and PBPC within 6 consecutive months, neutropenic
fever without signs of
infection was observed, which may be
sargramostim-related
fever. The typical presentation must fulfil the following criteria: cyclical elevation in body temperature that happens at the predicted time after
sargramostim administration; absence of other signs or symptoms of
infections; quick resolution of the
fever after onset
acetaminophen administration. Having met these criteria, none of these patients has been treated with intravenous
antibiotics for active
infections. At the time of haematological recovery (at a median time of 13 days from PBPC reinfusion to absolute neutrophil counts of > or = 0.5/nl) the febrile episode gradually resolved. No serious complications or other side-effects were observed. No toxic deaths occurred. Only if specific symptoms or signs of
infection develop, would intravenous empiric
antibiotic therapy be started.