HEMATOPOIETIC GROWTH-FACTOR (G-CSF OR GMCSF) AFTER SALVAGE CHEMOTHERAPY IN REFRACTORY OR RELAPSED ADULT DE-NOVO ACUTE-LEUKEMIA

Nineteen adults with primary refractory or relapsed acute leukemia (12 ALL and 7 ANLL) were treated with an intensive salvage chemotherapy ( intermediate-dose ara-C, intermediate-dose methotrexate, vindesine, cy clophosphamide, mitoxantrone and prednisolone) followed by a hematopoi etic growth factor (HGF), either granulocyte colony-stimulating factor (5 mu g/kg) or granulocyte-macrophage colony-stimulating factor (10 m u g/kg). Both were given from the day after chemotherapy ended and unt il the neutrophil count rose above 1 x 10(9)/l for three consecutive d ays. Eleven patients (58%, 95% CI 33% to 82%) achieved complete remiss ion, and 15 courses of salvage therapy were given to these complete re sponders, In a historical control group that did not receive HGF, 23 o ut of 38 patients (60%, 95% CI 44% to 77%) achieved complete remission , and 27 courses of therapy were delivered to complete responders. Tre atment with a HGF accelerated the recovery of neutrophils to 0.5 x 10( 9)/l significantly, shortening it from a mean of 28 to 22 days (p =.00 02), with no effect on platelet recovery. There were no differences in the rates of documented and fatal infections, which were relatively h igh in both groups. In the patients with ANLL, there was no evidence t hat HGF accelerated leukemic regrowth. We conclude that HGF accelerate s neutrophilic recovery following intensive salvage chemotherapy for a cute leukemia, although no reduction in documented infections was foun d. Many factors, including the small patient sample, may have contribu ted to this latter finding.