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Intensive short term therapy with granulocyte‐macrophage–colony stimulating factor support, similar to therapy for acute myeloblastic leukemia, does not improve overall results for adults with acute lymphoblastic leukemia
Author(s) -
Ifrah Norbert,
Witz Francis,
Jouet JeanPierre,
François Sylvie,
Lamy Thierry,
Linassier Claude,
Pig Bernard,
Berthou Christian,
Guyotat Denis,
Cahn JeanYves,
Harousseau JeanLuc
Publication year - 1999
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19991015)86:8<1496::aid-cncr16>3.0.co;2-#
Subject(s) - medicine , acute myeloblastic leukemia , lymphoblastic leukemia , leukemia , immunology , granulocyte macrophage colony stimulating factor , granulocyte , oncology , cytokine
Abstract BACKGROUND Despite modern treatment programs, less than 20% of adult cases of acute lymphoblastic leukemia (ALL) are cured. For relapsing and/or refractory patients, use of high dose cytosine arabinoside (ara‐C) and anthracyclin achieved a complete remission (CR) rate of up to a 75%. The aim of this study was to evaluate in adult patients with ALL 1) the CR rate of a chemotherapy schedule similar to a schedule for acute myeloblastic leukemia (AML) patients, 2) the antileukemic value and the tolerance of 3 intensive stage treatments, and 3) the impact of recombinant granulocyte‐macrophage–colony stimulating factor (rGM‐CSF) on chemotherapy‐induced neutropenia and infectious complications, as well as the effect of dose intensity. METHODS Between November 1990 and April 1992, 67 patients ages 15–55 years with de novo ALL were randomly assigned to receive either rGM‐CSF or placebo. The induction treatment consisted of idarubicin, methylprednisolone, and high dose ara‐C. After achieving CR, patients up to age 45 years who had an HLA‐identical sibling were assigned to undergo allogeneic bone marrow transplantation (BMT). All remaining patients received a first course of early intensification with high dose ara‐C, mitoxantrone, etoposide, and methylprednisolone, followed by autologous, unpurged BMT. RESULTS Of the 64 eligible patients, 50 (78%) achieved CR. Sixteen allogeneic and 18 autologous BMTs were performed. The median survival was 10.2 months. The 4‐year survival was 24%. rGM‐CSF only improved the incidence of severe mucositis during the induction course ( P = 0.003) and probably also improved the median duration of fever ( P = 0.07). CONCLUSIONS This schedule, similar to that for the treatment of AML patients, with early BMT included, did not prove to be a satisfactory approach to the treatment of most adult ALL patients, although CR was achieved in 78% of cases. In this study, no major improvement was obtained with rGM‐CSF therapy. Cancer 1999;86:1496–505. © 1999 American Cancer Society.