PERSPECTIVE OF RHGM-CSF IN THE TREATMENT OF NEUTROPENIC INFECTIONS AND AGGRESSIVE LYMPHOMAS

Non-Hodgkin lymphomas (NHL) of intermediate and high-grade malignancy respond well to doxorubicin-containing regimens, but long-term surviva l does not exceed 30% in large studies with long-term follow-up. Any a ttempt to improve this somehow disappointing result by adding more dru gs, increasing doses or shortening time intervals of chemotherapy have so far failed in randomized settings. Even autologous bone marrow tra nsplantation (ABMT) could not improve long-term survival when applied in first remission of the disease. Prophylactic use of hematopoietic g rowth factors in the chemotherapy of aggressive NHL did prevent neutro penia and positively influenced the occurrence of infectious complicat ions, and also led to an increase of dose intensity (DI) by 15% but th is did not affect survival. In contrast, a retrospective analysis of a n NHL study shelved that a high DI may in fact be deleterious rather t han beneficial. Thus the prophylactic use of hematopoietic growth fact ors still has to be considered experimental in the chemotherapy of NHL and should be studied in controlled settings like the one proposed he re.