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High‐dose cytarabine‐containing chemotherapy with or without granulocyte colony‐stimulating factor for children with acute leukemia
Author(s) -
Chen ShuHuey,
Liang DerCherng,
Liu HsiChe
Publication year - 1998
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/(sici)1096-8652(199805)58:1<20::aid-ajh4>3.0.co;2-2
Subject(s) - cytarabine , medicine , idarubicin , chemotherapy , mitoxantrone , gastroenterology , group b , sepsis , granulocyte colony stimulating factor , incidence (geometry) , pneumonia , leukemia , surgery , physics , optics
We sought to determine the role of granulocyte colony‐stimulating factor (G‐CSF) as an adjunct therapy in high‐dose cytarabine‐containing chemotherapy (HD C/T) for children with acute leukemia. Seventeen patients, aged 9 months to 18 years old, 8 ALL and 9 AML, were treated with cytarabine (Ara‐C) 1 g/m 2 q12h for 8 doses with mitoxantrone, idarubicin, VP‐16, or asparaginase. A total of 71 courses of HD C/T was given. G‐CSF was not used in 14 courses (Group A). Prophylactic G‐CSF was given in 57 courses (Group B) as 200 μg/m 2 /d SC started one day after the completion of HD C/T and continued until the neutrophil recovery was maintained. The incidences of sepsis per course in Group A and Group B were 35.7% (5/14) and 40.4% (23/57), respectively. While 2 patients in Group A died of sepsis or pneumonia, none in Group B died. The mortality and delay in chemotherapy were fewer in Group B ( P = 0.037 and 0.0006, respectively, Fisher exact test). There was a shorter average number of days of neutrophil <500/cumm, antibiotic usage, fever, and hospital stay in Group B (11, 8, 5, 17 days in Group B vs. 21, 17, 10, 37 days in Group A; P = 0.0001, log‐rank test; 0.0006, 0.0023, 0.0001, Wilcoxon rank sum test, respectively). The incidence of neutropenic fever was lower in Group B, but the difference did not reach statistical significance ( P = 0.06, Fisher exact test). We conclude that G‐CSF as an adjunct therapy in HD C/T is effective in reducing mortality, days of neutropenia, antibiotic usage, fever, hospital stay, and frequency of delay in chemotherapy. The efficacy of this treatment approach requires further testing in a randomized, controlled trial. Am. J. Hematol. 58:20–23, 1998. © 1998 Wiley‐Liss, Inc.