This group of patients with a low risk of complications

[1] is also the most common category of febrile neutropenic patients. Our patients were recruited from a clinical antibiotic trial [16] in which patients were randomized www.selleckchem.com/products/mi-503.html into two different dosing regimes of tobramycin. The results obtained comparing these two dosing regimens of tobramycin add information to the field of interaction between aminoglycosides and the host immunopathological response. Moreover, our patients participated in this study only once, thus avoiding bias related to the same patient providing several sets of results. Unfortunately, we did not collect samples beyond 2 days after the beginning of febrile neutropenia,

and our group Staurosporine of patients was relatively small. In general, our results were in accordance with results from similar studies in cancer patients with febrile neutropenia. Schuttrumpf et al. [24] previously found that most patients with a non-infectious cause of febrile neutropenia had PCT concentrations <0.5 μg/l. Bacteraemia with coagulase-negative staphylococci may not increase the PCT levels [25], whereas occasional patients with higher PCT values may not have any infection [26]. The median level of the proinflammatory IL-6 increased about 30% from 61 to 80 ng/l. Still these IL-6 levels were compatible with non-bacteraemic febrile episodes compared with previous studies [27–31]. Median IL-8, INFγ and TNFα were low both in the first and in the second samples. All IL-8 values were <1000 ng/l, a cut-off value usually suggesting an increased risk of bacteraemia [32]. Engervall et al. [27] underlined, however, that both pro- and anti-inflammatory cytokines tend to be elevated at the beginning of febrile

neutropenia. Other studies show that cytokine concentrations are not predictive of bacteraemia in febrile neutropenic patients [33]. IL-6 and IL-8 seem to be the two cytokines most strongly associated with bacteraemia, and low levels of these cytokines Urocanase have a high negative predictive value [28]. Likewise, high levels of the anti-inflammatory IL-10 are associated with persistent bacteraemia, the mechanism thought to be a condition of immunoparalysis with reduced ability to clear the infecting agent [30]. Different cytokine measurement standardizations in different studies make absolute levels difficult to compare [34]. Most studies of inflammatory response markers include episodes of febrile neutropenia where the same patient may participate several times [9, 10, 12, 14, 15, 27–31, 34–37], adding to the problems of comparing different studies. The clinical condition of our patients during the first couple of days of febrile neutropenia was only mildly deteriorated. The MASCC scores ≥21 in 92% of our patients suggested a low risk of complications [1]. The study of Uys et al.