COMPARATIVE EFFECTS OF GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR AND GRANULOCYTE-COLONY-STIMULATING FACTOR AFTER HIGH-DOSE CYCLOPHOSPHAMIDE CANCER-THERAPY

Purpose: We compared hematologic and clinical effects of granulocyte-m acrophage colony-stimulating factor (GM-CSF) and granulocyte colony-st imulating factor (G-CSF) after treatment with high-dose cyclophosphami de (HD-CTX, 7g/m(2)), given as the first phase of a high-dose sequenti al chemotherapy program that includes a myeloablative therapy with mob ilized progenitor cell autografting. Patients and Methods: Forty-nine consecutive patients with non-Hodgkin's lymphoma, Hodgkin's disease, o r poor-prognosis breast cancer received GM-CSF (n=27) or G-CSF (n=22) after HD-CTX in two consecutive, nonrandomized studies. Cytokines were administered in continuous intravenous (IV) infusion for 14 to 15 day s at a median dose of 5.5 and 10 mu g/kg/d, respectively, starting 24 hours after HD-CTX. Results: Neutrophil recovery was faster with G-CSF administration (11.5 v 13.2 days; P=.01), whereas platelet counts rec overed more rapidly with GM-CSF(13.7 v 16.6 days; P=.01). Prophylactic platelet transfusions were administered more frequently to patients t reated with G-CSF than with GM-CSF (66% v 22% of the patients; P=.02). No clinically significant difference was observed between the two gro ups concerning days of absolute neutropenia or neutropenic fever, Both cytokines reduced the rime to eligibility for subsequent chemotherapy administration compared with historical controls not given cytokine ( 14 to 16 v 20 days). Both cytokines increased circulation of hematopoi etic progenitors. Most side effects were World Health Organization (WH O) median grade 1 to 2, were more frequent during GM-CSF than during G -CSF treatment, and were reversible by simple supportive measures and/ or by dose reduction or suspension of the cytokine. Permanent suspensi on of cytokine administration was never required in either group. Conc lusion: GM-CSF or G-CSF administration after HD-CTX reduces hematologi c toxicity of high-dose chemotherapy and induces circulation of large amounts of hematopoietic progenitors suitable for autografting in canc er patients. (C) 1996 by American Society of Clinical Oncology.