Neutropenia and fever in patients undergoing combination chemotherapy for malignant germ cell tumors of the ovary

Fifteen neutropenic febrile episodes occurred in 29 patients undergoing chemotherapy for malignant germ cell rumors of the ovary. Vincristine, actinomycin-D, and cyclophosphamide were used in 24 patients; cis-diamminedichloroplatinum, vinblastine, and bleomycin in three; and both regimens in two. All 15 patients were treated with antibiotic combinations (gentamicin and clindamycin in 12 cases), usually until neutropenia resolved. The mean nadir total granulocyte count was 123/mm³ There was no septicemia or drug-related deaths. With reduction in chemotherapy dosage, 87% of patients tolerated subsequent courses. The survival rates in this disease are excellent, although toxicity is substantial from both regimens. These neutropenic febrile episodes can be managed successfully without interrupting chemotherapy. (C) 1986 The American College of Obstetricians and Gynecologists.