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Treatment of poor-prognosis, newly diagnosed acute myeloid leukemia with
ara-C and recombinant human granulocyte-macrophage colony- stimulating
factor
EH Estey, D Dixon, HM Kantarjian, MJ Keating, K McCredie, GP Bodey, R Kurzrock, M Talpaz, EJ Freireich and AB Deisseroth
Department of Hematology, University of Texas M.D. Anderson Cancer Center,
Houston 77030.
We administered recombinant granulocyte-macrophage colony-stimulating
factor (GM-CSF) (120 micrograms/m2/d by continuous intravenous [IV]
infusion) to 12 patients with newly diagnosed acute myeloid leukemia (AML)
at relatively high risk of early death during remission induction. GM-CSF
began 3 days after completion of induction chemotherapy (ara-C 1.5 g/m2 d x
4 days by continuous IV infusion after a 3 g/m2 bolus). Rates of fatal
infection (42%), pneumonia and/or sepsis (83%), and CR (50%) did not differ
significantly (P less than .05) from those observed after administration of
the identical chemotherapy without GM-CSF to 53 historical controls with
newly diagnosed AML at similarly high risk of early death. There were no
significant differences between the GM-CSF-treated and the historical
groups in the time required to reach neutrophil counts of 500 or
1,000/microL after administration of chemotherapy. Four patients died of
infection before they could have benefited from the earliest recovery of
neutrophil count observed in patients who entered CR. Growth of leukemia
after GM-CSF administration was observed in only 1 of the 8 patients who
survived long enough for response to induction therapy to be fully
evaluated. This observation suggests that it might be safe to undertake
larger, randomized studies, perhaps using earlier administration of GM-CSF,
to definitively determine the role of GM-CSF added to chemotherapy in
patients with newly diagnosed AML.
Volume 75,
Issue 9,
pp. 1766-1769,
05/01/1990
Copyright © 1990 by The American Society of Hematology
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