Stem cell reinfusion was performed on day 0. Granulocyte colony-stimulating factor (G-CSF) bone marrow support was not part of the treatment plan and was only given to one patient. Blood samples were drawn after inclusion, before initiation of antibiotic treatment and 1–2 days later when the first sample selleck chemical for tobramycin serum concentration was drawn. The median time interval

from the onset of antibiotic therapy until the collection of the second sample was 24 h (range 16–56 h). The samples were spun down, and serum and EDTA plasma were frozen at−70 °C within 2 h of being drawn. One hundred patients recruited from The Norwegian Radium Hospital, Oslo University Hospital, participated in the clinical trial [16]. Blood samples from 61 of these patients were available for this study, while the remaining 39 patients did not have the necessary blood samples collected according to the protocol for various logistic reasons. However, their clinical courses did not differ from the 61 patients participating in this study. All the 61 patients included in this study developed febrile neutropenia. Fifty-six patients had the first blood sample drawn according to the protocol, and all 61 patients had the second blood samples drawn. Demographic and medical

characteristics are presented in Table 1. Thirty-two patients received tobramycin once daily, and 29 patients received tobramycin three times daily. The three-times-daily group all received an initial double dose of tobramycin. The daily doses thereafter were similar among the two groups, median 6.0 mg/kg, range 5.5–7.1 mg/kg. Selleckchem Sirolimus Trough median and range values were 0.7 and 0.3–3.3 mg/l in the three-times-daily group, and 0.2 and 0.0–1.1 mg/l in the once-daily group. Peak median and range values were 5.9 and 3.0–9.2 mg/l in the three-times-daily group,

and 15.8 and 10.4–27.9 mg/l in the once-daily group. The patients were classified as having none to mild symptoms, moderate or severe symptoms according to a previously described method [18] at the time when febrile neutropenia was diagnosed and when the first tobramycin serum concentration was collected. Their MASCC Thalidomide scores [1] were calculated at the same time. The most common symptoms and signs observed were fever, fatigue, nausea, vomiting and oral mucositis. CRP and PCT.  C-reactive protein (CRP) (milligram per litre) in plasma was determined by a high-sensitive particle-enhanced immunoturbidometric assay (Roche Diagnostica, Mannheim, Germany). PCT (microgram per litre) in plasma was determined by the BRAMHS PCT-sensitive KRYPTOR Model F Mono Cavro that uses a time-resolved amplified cryptate emission technology (Brahms Diagnostica, Hennigsdorf, Germany). Complement activation products.  The C3 complement activation product C3bc and the terminal soluble C5b-9 complex (TCC) were quantified using enzyme-linked immunosorbent assay (ELISA), as described previously [19, 20]. MBL.