The pathogenesis of fungal infection highlights the relative importance of the different components of host defense, particularly in the immunocompromised patient. Deficiency in number and function of white cells is especially correlated with the degree and progression of disease in many patient populations. Newly developed research is directed at using cytokines as immunomodulators in both neutropenic and nonneutropenic patients [94]. Four cytokines (granulocyte colony-stimulating factor, granulocyte-macrophage colonystimulating factor, macrophage colony-stimulating factor, and interferon gamma) have been used as adjuvant therapy for proven fungal infections in this setting, although clinical experience is still too limited to be evaluated. There have been reports of use of these agents as adjuncts to AmB therapy, but the data are insufficient to derive any conclusions [95]. As an additional approach, the concept of white blood cell transfusions has been revived by the use of granulocyte colony-stimulating factor to increase the yield from donors and may prove helpful in the setting of short-term neutropenia.
Repair of chemotherapy-induced mucositis is a desirable goal, and keratinocyte growth factor (KGF) is undergoing clinical trials. Interleukin-11 is now approved by the FDA as a thrombopoietic agent, but it also has reparative effects on the mucosa in vitro and in animal models.
Course Number: V035B.043001
This CME Expires on July 1, 2003; no tests will be accepted after this date.
This course is accredited by
The University of Pittsburgh School of Medicine, Center for Continuing Education
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