Multicentre Canadian Clinical Trials on Neutropenic Patients

N EUTROPEN!A (USUALLY DEFINED AS LESS T l-!AN 500 neutrophils per microlitre) is occuning more fre quently because of the increasing use of aggressive approaches for the tr atment of malignant disease as well as new indications for immunosuppressive chemotherapeutic agents such as cyclophosphamide . The majority of neutropenic patients are patients with solid tumours. hematological malignancies (acute and chronic leukemias and lymphomas) and those undergoing bone marrow transplantation (autologous or allogeneic); the latter are primarily patients with malignant disease. Neutropenia predisposes to infectious complications and makes it difficult for patients to respond to appropriate antimicrobial therapy. A number of factors associated with neutropenia influence outcomes in patients treated for fever associated with their neutropenia, including degree of neutropenia, duration of neutropenia , underlying malignancy. state of the underlying malignancy, organism cultured (if any) and site of infection. The relationship of these factors to outcome will be addressed briefly. Patients with severe neutropenia (less than 100/~tL) have a much greater chance of developing infection and are much less likely to respond to appropriate antimicrobials. This must be considered when designing clinical trials and when in terpreting publications dealing with such trials. The duration of neutropenia is also very important. Patients whose neutrophil count drops to below 500/p.L for a few days and even up to a week , usually have a very good outcome regardless of the empiric antibiotic