G-CSF Diminishes the Toxicity of Remission Induction Therapy in Acute Lymphoblastic Leukemia in Adults
ABSTRACT & COMMENTARY
Synopsis: A randomized study of 51 patients has shown that Granulocyte-Colony-Stimulation Factor significantly reduced the duration of neutropenia, the incidence of febrile neutropenia, and documented infections, and had no effect on the complete response rate or remission duration.
Source: Geissler K, et al. Blood 1997;90:590-596.
With the most recent advances in treatment, about 75% of adults with acute lymphoblastic leukemia (ALL) achieve a complete response. About 10% of patients die as a consequence of complications of the treatment induction, especially bacterial and fungal infections mainly related to marrow suppression. Granulocyte-Colony-Stimulating Factor (G-CSF) use during remission induction has not been extensively studied. Geissler and colleagues conducted a multicenter, randomized study in Austria of 51 patients with acute lymphoblastic leukemia. Patients were treated with a modification of the German Cooperative Multicenter ALL (GMALL) protocol in which a higher dose of daunorubicin (45 mg/m2) was used and a different, more potent preparation of asparaginase permitted reduction of the dose to 2500 U/m2.
G-CSF (5 mcg/kg) was given subcutaneously daily beginning 24 hours after the first daunorubicin dose to 25 patients and was continued until marrow recovery. Twenty-six patients received the same therapy without G-CSF. Patients receiving G-CSF had significantly fewer neutropenic days (29% of hospital days vs 84% for the group without G-CSF; P < 0.00005) and recovered neutrophil counts of more than 1000/mcL significantly sooner (16 days vs 26 days; P < 0.0005) than controls. Patients receiving G-CSF also had less febrile neutropenia (12% vs 42%; P < 0.05) and fewer documented infections than controls. There were no differences in transfusion requirements. Treatment outcome of the leukemia was similar in the two groups (96% CR rate on G-CSF; 80% for controls). G-CSF is a useful adjunct to induction chemotherapy in adult acute lymphoblastic leukemia.
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