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Hematopoietic growth factors as adjuncts to the treatment of acute myeloid
leukemia
CA Schiffer
Division of Hematologic Malignancies, University of Maryland Cancer Center,
University of Maryland School of Medicine, Baltimore 21201, USA.
A number of randomized trials have recently been completed evaluating the
effect of hematopoietic growth factors (granulocyte-macrophage
colony-stimulating factor or granulocyte colony-stimulating factor) as
adjuncts to the treatment of patients with acute myeloid leukemia. Most
studies used the growth factors to decrease the duration of neutropenia
with the hope of reducing infectious morbidity and mortality. The results
of these trials are generally quite consistent. Virtually all trials showed
a modest reduction in the duration of severe neutropenia with a variable
effect on the incidence of severe infections, antibiotic usage, and the
duration of hospitalization. There was no consistent benefit in terms of
improvements in complete response rate, complete response duration, or
overall survival. However, it is important that there does not appear to be
an increase in the incidence of drug-resistant leukemia in trials in which
the growth factor was begun after completion of the chemotherapy. Other
trials administered growth factors either before or simultaneous with the
chemotherapy in an attempt to enhance chemosensitivity and decrease drug
resistance. None of these trials, whether conducted as part of initial
induction therapy or in relapse, showed improvements in response rate or
survival. Lastly, some anecdotal reports have suggested that occasional
patients who receive growth factors as the only therapy for overt leukemia
can achieve remission, possibly through a differentiating effect of the
growth factor. However, there are very few such reports, and growth factor
use in this situation is potentially dangerous and should be performed only
in the context of a clinical trial. In summary, there appears to be no role
at this time for priming of leukemia cells by growth factors to enhance the
effect of chemotherapy, and more in vitro studies should be performed
before further clinical trials of this approach. It is clear that growth
factors administered after induction and possibly consolidation
chemotherapy can shorten the duration of neutropenia, without a significant
effect on treatment outcome. It is as yet unclear whether the use of growth
factors in this fashion is cost effective.
Volume 88,
Issue 10,
pp. 3675-3685,
11/15/1996
Copyright © 1996 by The American Society of Hematology
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