Granulocyte colony-stimulating factor shortens duration of critical neutropenia and prolongs disease-free survival after sequential high-dose cytosine arabinoside and mitoxantrone (S-HAM) salvage therapy for refractory and relapsed acute myeloid leukemia |
| |
Authors: | W. Kern C. Aul G. Maschmeyer R. Kuse A. Kerkhoff A. Grote-Metke H. Eimermacher U. Kubica B. Wörmann T. Büchner W. Hiddemann |
| |
Affiliation: | (1) Georg-August-University, Department of Hematology and Oncology, Robert-Koch-Strasse 40, D-37075 Gottingen, Germany e-mail: whiddema@med.uni-Goettingen.de, Tel.: 0049-551-39-8535, Fax: 0049-551-39-2914, DE;(2) Department of Hematology and Oncology, University of Düsseldorf, Germany, DE;(3) Evangelisches Krankenhaus Essen-Werden, Germany, DE;(4) Krankenhaus St. Georg, Hamburg, Germany, DE;(5) Department of Hematology and Oncology, University of Münster, Germany, DE;(6) Evangelisches Krankenhaus, Hamm, Germany, DE;(7) Katholisches Krankenhaus, Hagen, Germany, DE;(8) Zentralkrankenhaus St. Jürgen, Bremen, Germany, DE |
| |
Abstract: | Patients with primary refractory or relapsed acute myeloid leukemia (AML) who undergo intensive salvage chemotherapy carry a high risk of treatment failure due to infectious complications and early relapses. The study presented here assessed the effect of granulocyte colony-stimulating factor (G-CSF) on the duration of post-treatment neutropenia, the incidence of infection-related deaths, and the disease-free and overall survival. Sixty-eight evaluable patients with relapsed and refractory AML received G-CSF 5 μg/kg per day subcutaneously starting 2 days after the completion of salvage treatment with the S-HAM regimen, consisting of high-dose cytosine arabinoside twice daily on days 1, 2, 8, and 9 and mitoxantrone on days 3, 4, 10, and 11. Ninety-one patients who were treated with the identical S-HAM regimen but without G-CSF support during a preceding study served as controls. The application of G-CSF resulted in a significant shortening of critical neutropenia of less than 500 μl (36 vs. 40 days;p=0.008), which translated into a trend towards a lower early death rate (21% vs. 30%) and an increase of complete remissions (56% vs. 47%, p=0.11). In patients younger than 60 years a significant prolongation of time to treatment failure (159 vs. 93 days, p=0.038) and of duration of disease-free survival (203 vs. 97 days, p=0.003) was observed. These results indicate a beneficial effect of G-CSF on early mortality as well as on long-term outcome when administered after S-HAM salvage therapy for advanced AML. |
| |
Keywords: | G-CSF AML Cytosine arabinoside Refractory disease Salvage therapy |
本文献已被 SpringerLink 等数据库收录! |
|