G-CSF Administered in Time-sequenced Setting During Remission Induction and Consolidation Therapy of Adult Acute Lymphoblastic Leukemia has Beneficial Influence on Early Recovery and Possibly Improves Long-term Outcome: A Randomized Multicenter Study

Abstract

Sixty-four untreated adult acute lymphoblastic leukemia (ALL) patients were randomized to receive chemotherapy alone, n = 31 or chemotherapy and granulocyte colony stimulating factor (G-CSF), n = 33. During induction patients received G-CSF for 5 days between four weekly Epirubicin+Vcr administrations, starting 36 h after each application and finishing 48 h before the next one with the intention to possibly generate a cell cycle dependent protection of normal hematopoietic progenitors and to stimulate granulopoiesis. The complete remission (CR) rate equaled 94% in the G-CSF group and 87% in controls. Patients who received G-CSF, if compared to the controls, had shorter granulocytopenia during induction and consolidation, displayed a lower infection rate, completed the induction-consolidation quicker and stayed shorter in hospital during induction, p < 0.001-0.04. Follow-up at 2 years revealed a rather higher probability of survival (59 vs. 27%, p = 0.04) and a lower relapse rate (32 vs. 60%) in G-CSF arm than in controls. The beneficial influence of G-CSF administered in time-sequenced fashion on survival needs further confirmation.

Tratamiento de la leucemia linfoide aguda del adulto: Experiencia de un hospital en la Ciudad de México

“…Semejante a lo sucedido en la experiencia de Puga y cols en Chile, la disposición de factores estimulantes de crecimiento fue limitada siendo un factor signifi cativo en los éxitos de la terapia de inducción 26 . Algunos autores han referido que su administración puede infl uir en el porcentaje de RC debido a la disminución de los procesos infecciosos severos 27 , pero en general se considera que disminuyen el tiempo de duración de la neutropenia y disminuyen el tiempo de estancia hospitalaria 28,29 . En cuanto al tratamiento de los episodios de neutropenia febril, este se realizó acorde a las consideraciones internacionales.…”

Addition of cladribine to daunorubicin and cytarabine increases complete remission rate after a single course of induction treatment in acute myeloid leukemia. Multicenter, phase III study

“…22 The remission status was assessed after completion of each course of induction treatment, after the end of consolidation, before every two maintenance courses and every 3 months after the end of maintenance, or after HSCT, unless earlier bone marrow examinations were indicated by peripheral blood changes inconsistent with CR.…”

Colony-stimulating factors for chemotherapy-related febrile neutropenia are associated with improved prognosis in adult acute lymphoblastic leukemia

“…Five of the included studies used G-CSF and two used GM-CSF (20)(21)(22)(23)(24)(25)(26). The commonly used dosage of G-CSF and GM-CSF is 5 µg/kg.…”

“…In total, 6 studies reported on neutropenia duration (20)(21)(22)(24)(25)(26). In these studies, neutropenia was defined as <0.5x10 9 /l neutrophils.…”