The past decade has produced tremendous advances in the support of neutropenic patients undergoing chemotherapy or transplant procedures in the form of potent broad-spectrum antimicrobials, hemopoietic growth factors, and stem cell transfusions. Hemopoietic growth factors and stem cell therapy have reduced the period of neutropenia following chemotherapy and have allowed dose intensification of chemotherapy with a possibility of better cure rates for some malignancies. Because of their potent broad-spectrum activity, the newer antimicrobials have made the neutropenic phase relatively safer with a significant reduction in morbidity and mortality. Many patients with congenital neutropenia (e.g. Kostmann's syndrome and cyclical neutropenia) have also benefited from these advances. Unfortunately, these supportive measures are all very expensive and have important implications for the health care budget. Therefore it is imperative that the potential benefits of these measures are properly validated. Clear guidelines for their use in clinical practice are essential.
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