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Recombinant human granulocyte-macrophage colony-stimulating factor after
chemotherapy in patients with acute myeloid leukemia at higher age or after
relapse
T Buchner, W Hiddemann, M Koenigsmann, M Zuhlsdorf, B Wormann, A Boeckmann, EA Freire, G Innig, G Maschmeyer and WD Ludwig
Department of Hematology/Oncology, University of Munster, Germany.
To reduce critical neutropenia after chemotherapy (CT) for acute myeloid
leukemia (AML) we administered recombinant human granulocyte- macrophage
colony-stimulating factor (GM-CSF) to patients over the age of 65 years
with newly diagnosed AML and to patients with early or second relapse. CT
was 9-day 6-thioguanine, ara-C, and daunorubicin (TAD9) in newly diagnosed
AML and sequential high-dose ara-C and mitoxantrone (S-HAM) for relapse. In
patients whose bone marrow was free from blasts a continuous intravenous
infusion of GM-CSF 250 micrograms/m2/d started on day 4 after CT.
Thirty-six patients entered the study and 30 of them did receive GM-CSF.
For comparison, a historical control group of 56 patients was used.
Complete remission rate was 50% (18 of 36) versus 32% in controls (P =
.09), and early death rate was 14% versus 39% (P = .009). Treatment with
GM-CSF was not associated with major adverse events. Two patients showed a
marked leukemic regrowth that was completely reversible in one patient and
appeared to be GM-CSF independent in the other patient. Remission duration
does not seem to be reduced after GM-CSF. Under GM-CSF the blood
neutrophils recovered 6 and 9 days earlier in the TAD9 (P = .009) and S-HAM
(P = .043) groups associated with a rapid clearance of infections in most
patients. We conclude that GM-CSF was of therapeutic benefit to our
patients and this provides a basis for larger controlled trials.
Volume 78,
Issue 5,
pp. 1190-1197,
09/01/1991
Copyright © 1991 by The American Society of Hematology
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