USE OF CONTINUOUS-INFUSION GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR ALONE OR FOLLOWED BY GRANULOCYTE-COLONY-STIMULATING FACTOR ENHANCE ENGRAFTMENT FOLLOWING HIGH-DOSE CHEMOTHERAPY AND AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR LYMPHOID MALIGNANCIES

We evaluated the differences in engraftment and toxicities post-autolo gous transplant using granulocyte-macrophage colony stimulating factor (GM-CSF) as a continuous infusion either alone or in a sequential man ner with granulocyte colony-stimulating factor (G-CSF). Patients recei ving high-dose chemotherapy and autologous bone marrow transplantation (ABMT) for lymphoid malignancies participated in two phase II trials evaluating either continuous infusion GM-CSF (GM-CSF (CI)) or continuo us infusion GM-CSF followed by sequential G-CSF (GM-CSF/G-CSF) adminis tered post-ABMT. These patients were compared to similar historical co ntrol patients receiving GM-CSF administered as a 2-h intravenous (i.v .) infusion (GM-CSF (2-h)). Patients receiving GM-CSF (CI) and GM-CSF/ G-CSF had a median day to reach an absolute neutrophil count of 500/mu l post-ABMT of 12 and 11 days, respectively. This compared to a media n day of 22 in the GM-CSF (2-h) historical control patients. The media n day to platelet independence was 18, 18 and 30 days, respectively. T he incidence of toxicities such as incidence of infection, pleural eff usions, and rash did not differ greatly between the groups. We conclud e that the use of continuous infusion GM-CSF either alone or sequentia lly with G-CSF produced improved engraftment times compared to histori cal control patients treated with GM-CSF as a 2-h i.v. infusion. The t oxicities at a reduced dose of 125 mu g/m(2) given as a continuous inf usion appear to be similar to those seen in patients receiving GM-CSF as a 2h infusion.