Granulocyte-macrophage colony-stimulating factor as infection prophylaxis in high-risk oncologic surgery

Background A method of augmenting host defenses against bacterial pathogens could result in a decrease in postoperative infections. Given its effects on leukocyte proliferation and function, it is possible that prophylactic granulocyte-macrophage colony-stimulating factor (GM-CSF) could reduce the incidence and severity of infections in high-risk surgical patients. The current study was undertaken to determine the safety and hematologic effects of perioperative GM-CSF. Methods Cancer patients undergoing operations with a high risk of postoperative infection were treated perioperatively for 10 days with subcutaneous GM-CSF. Cohorts were treated with GM-CSF at 125 μg/m2/day (12 patients) and 250 /μg/ m2/day(11 patients). Results There were no severe or life-threatening toxicities associated with GM-CSF. Mean maximum neutrophil counts during the first 5 postoperative days were 16.3 ± 9.14 and 24.5 ± 7.60 at 125 and 250 μg/m2, respectively (P = 0.04). Only one wound infection was diagnosed during this study. Conclusions GM-CSF may be safely administered perioperatively at doses that augment neutrophil number and function. An ongoing randomized clinical trial will determine the impact of GM-CSF on postoperative infection.