Concomitant granulocyte colony-stimulating factor and induction chemoradiotherapy in adult acute lymphoblastic leukemia: a randomized phase III trial

Abstract

This prospective multicenter study examined whether simultaneous administration of granulocyte colony-stimulating factor (G-CSF; Filgrastim) and induction chemotherapy for adult acute lymphoblastic leukemia (ALL) could prevent treatment-related neutropenia, infections, and resulting treatment delays. Seventy-six patients were randomly assigned to receive either G-CSF (n = 37) or no growth factor (n = 39) in conjunction with a uniform chemotherapy consisting of cyclophosphamide, cytarabine, mercaptopurine, intrathecal methotrexate, and cranial irradiation. The median duration of neutropenia (absolute neutrophil count < 1 x 10(9)/L) during chemotherapy was 8 days in patients receiving C-CSF, compared with 12.5 days in the control group (P < .002). A similar reduction from 11.5 to 7 days was observed in patients with T-ALL receiving additional mediastinal irradiation (P = .13). Infections occurred in 43% and 56% of patients in the G-CSF and control arm, respectively (P = .25); the incidence of nonviral infections was reduced by 50%, from 32 episodes in the control arm to 16 episodes in the G-CSF arm. Prolonged interruptions of chemotherapy administration were less frequent, with delays of 2 weeks or more occurring in only 24% of patients receiving G-CSF as opposed to 46% in the control arm (P = .01). Accordingly, chemotherapy was completed significantly earlier with the use of G-CSF (39 v 44 days, P = .008). With a median follow-up of 20 months, the probability of disease-free survival was 0.45 in the G-CSF group and 0.43 in the control group (P = .34). In conclusion, adult ALL patients appear to benefit by the simultaneous administration of G-CSF with induction chemotherapy because of a significant reduction in the duration of neutropenia, a trend to fewer infections, and a more rapid completion of chemotherapy.

A national French survey on the use of growth factors as adjuvant treatment of chronic hepatitis C

“…Anemia is indeed more often symptomatic than neutropenia. Nevertheless, the use of G‐CSF has revolutionized the field of dose‐intensive chemotherapy by reducing neutropenia‐related complications 34, 35. As regards chronic hepatitis C, no official guidelines have been set for the use of G‐CSF, probably because of the absence of firm data resulting in an increased sustained viral response or reduced infections.…”

Morphological and cytochemical findings in 150 cases of T‐lineage acute lymphoblastic leukaemia in adults

“…From 1 January 1991 to 15 February 1995, 150 newly diagnosed cases of T-lineage ALL were studied by the central diagnostic review panel of the GMALL (Hoelzer et al, 1988;Ottmann et al, 1995). Morphological work-up and immunophenotyping of all cases was centralized.…”

High-dose cytarabine-containing chemotherapy with or without granulocyte colony-stimulating factor for children with acute leukemia

“…In recent clinical trials, the use of granulocyte colonystimulating factor (G-CSF) after intensive chemotherapy has been associated with reductions in the severity and duration of myelosuppression, morbidity, and mortality from myelosuppression-related complications [7][8][9][10][11][12]. In addition, the incidences of treatment delays decreased [12,13].…”