Granulocyte colony-stimulating factor ameliorates toxicity of intensification chemotherapy for acute lymphoblastic leukemia

✍ Scribed by Clarke, V.; Dunstan, F.D.J.; Webb, D.K.H.

• Publisher: John Wiley and Sons
• Year: 1999
• Tongue: English
• Weight: 72 KB
• Volume: 32
• Category: Article
• ISSN: 0098-1532
• DOI: 10.1002/(sici)1096-911x(199905)32:5<331::aid-mpo4>3.0.co;2-m

✦ Synopsis

Background. Intensification chemotherapy improves the prognosis for children with acute lymphoblastic leukemia (ALL), but results in considerable morbidity, primarily due to myelosuppression with resultant neutropenia. Recombinant granulocyte colony-stimulating factor (G-CSF) shortens neutropenia following intensive chemotherapy, but potential benefits in the therapy of ALL remain inadequately explored. Accordingly, a randomized, crossover study was undertaken to clarify this issue. Procedure. Seventeen children with acute lympho- blastic leukemia or T-cell non-Hodgkin lymphoma and treated on standard protocols were randomized to receive G-CSF following either the first or second intensification blocks of chemotherapy. G-CSF was administered as a single daily subcutaneous injection of 5 mcg/kg from day 9 following the start of intensification therapy, and continued until the neutrophil count exceeded 0.5 × 10 9 /l for 3 days. Study endpoints were days of neutropenia (neutro-phils <1 × 10 9 /l) and severe neutropenia (neutrophils <0.5 × 10 9 /l), days in hospital, days of fever, and days on antibiotics. Results. There were significant reductions in the duration of neutropenia (95% confidence interval 3.8-8 days, P = 0.0001), severe neutropenia (95% confidence interval 1.8-7.4 days, P = 0.002), and days in hospital (95% confidence interval 0.9-6.3 days, P = 0.01) for children receiving G-CSF. Overall, the duration of neutropenia was longer following the second block (95% confidence interval 2.2-6.4 days, P = 0.0003), but this difference was abolished by G-CSF, and children receiving G-CSF after the second intensification were more likely to restart maintenance chemotherapy on schedule (P = 0.05). Conclusions. G-CSF reduces the hematological toxicity of intensification chemotherapy and may allow improved compliance with treatment scheduling. Med. Pediatr. Oncol. 32: 331-335, 1999.