GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR (GM-CSF) AFTER CYCLOPHOSPHAMIDE TREATMENT IN THE 1983 BFM ACUTE LYMPHOBLASTIC-LEUKEMIA PROTOCOL IMPROVES DELIVERY OF SCHEDULED CHEMOTHERAPY

Of 44 children treated before 1992 with the ALL-BFM 1983 medium risk s chedule, 24 experienced a delay in or reduction of scheduled chemother apy in the two weeks after cyclophosphamide (CP) administrations. Infe ctions occurred in 24.5% and a blood transfusion was administered in 5 0.9% of these periods. E. coli recombinant human GM-CSF was given for 7 days, starting on day 4 after CP, to 11 consecutive children treated with the ALL-BFM 83 schedule after 1992. Serial full blood counts and liver function tests were preformed. A delay in scheduled treatment o ccurred in one patient. Infections occurred in 42.4% and a blood trans fusion was administered in 48.5% of observation periods. Transient ele vations of SGPT and SGOT were observed in both controls and patients, especially when L. asparaginase had preceded CP. No side effects of no te were associated with GM-CSF therapy. The addition of GM-CSF signifi cantly improved the ability to deliver scheduled chemotherapy. The inf ections did not delay planned therapy. Nine of 11 patients are in cont inued remission after 18-35 months (mean 27) follow-up. One child is i n second remission after a CNS relapse, which was treated with chemoth erapy followed by a marrow transplant.