Granulocyte colony-stimulating factor ameliorates toxicity of intensification chemotherapy for acute lymphoblastic leukemia

Clarke, V., Dunstan, Frank David John ORCID: https://orcid.org/0000-0002-1043-5281 and Webb, D. K. 1999. Granulocyte colony-stimulating factor ameliorates toxicity of intensification chemotherapy for acute lymphoblastic leukemia. Medical and Pediatric Oncology 32 (5) , pp. 331-335. 10.1002/(sici)1096-911x(199905)32:5%3C331::aid-mpo4%3E3.0.co;2-m

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Abstract

Background Intensification chemotherapy improves the prognosis for children with acute lymphoblastic leukemia (ALL), but results in considerable morbidity, primarily due to myelosuppression with resultant neutropenia. Recombinant granulocyte colony-stimulating factor (G-CSF) shortens neutropenia following intensive chemotherapy, but potential benefits in the therapy of ALL remain inadequately explored. Accordingly, a randomized, crossover study was undertaken to clarify this issue. Procedure Seventeen children with acute lymphoblastic leukemia or T-cell non-Hodgkin lymphoma and treated on standard protocols were randomized to receive G-CSF following either the first or second intensification blocks of chemotherapy. G-CSF was administered as a single daily subcutaneous injection of 5 mcg/kg from day 9 following the start of intensification therapy, and continued until the neutrophil count exceeded 0.5 × 109/l for 3 days. Study endpoints were days of neutropenia (neutrophils <1 × 109/l) and severe neutropenia (neutrophils <0.5 × 109/l), days in hospital, days of fever, and days on antibiotics. Results There were significant reductions in the duration of neutropenia (95% confidence interval 3.8–8 days, P = 0.0001), severe neutropenia (95% confidence interval 1.8–7.4 days, P = 0.002), and days in hospital (95% confidence interval 0.9–6.3 days, P = 0.01) for children receiving G-CSF. Overall, the duration of neutropenia was longer following the second block (95% confidence interval 2.2–6.4 days, P = 0.0003), but this difference was abolished by G-CSF, and children receiving G-CSF after the second intensification were more likely to restart maintenance chemotherapy on schedule (P = 0.05). Conclusions G-CSF reduces the hematological toxicity of intensification chemotherapy and may allow improved compliance with treatment scheduling.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Subjects:	R Medicine > R Medicine (General) R Medicine > RJ Pediatrics R Medicine > RZ Other systems of medicine
Publisher:	Wiley
ISSN:	0098-1532
Last Modified:	27 Oct 2022 08:55
URI:	https://orca.cardiff.ac.uk/id/eprint/63760

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