EFFECT OF GRANULOCYTE-COLONY-STIMULATING FACTOR IN PATIENTS WITH DIFFUSE LARGE-CELL LYMPHOMA TREATED WITH INTENSIVE CHEMOTHERAPY

We investigated whether Granulocyte colony-stimulating factor (G-CSF) could prevent myelotoxicity or accelerate hematopoietic recovery after intensive chemotherapy in previously untreated patients with diffuse large cell lymphoma (DLCL). Forty-two patients were included in a pros pective clinical trial in which alternating chemotherapy ESAP (etoposi de, Solu-Medrol, cytosine arabinoside, cis-platinum), m-BECOD (low dos es methotrexate, bleomycin, epirubicin, cyclophosphamide, vincristine, dexamethasone), MVPP-Bleo (mitoxantrone, vincristine, prednisone, pro carbazine, bleomycin) were administered by 9 cycles. Each cycle was fo llowed by 10 days of G-CSF (5 ug/kg/day) started five days after chemo therapy compared to a control group which received chemotherapy withou t G-CSF support. Leucocytes and granulocytes were significantly higher in patients receiving G-CSF compared to the control group. The total number of days of leukopenia (WBC counts below 2.0 x 10(9)/L and absol ute granulocytes below 1.0 x 10(9)/L) were longer in the patients with out G-CSF compared to those who received G-CSF (14.1 days versus 1.9 d ays). Delays in treatment were most frequent in the control group: 38% versus 4% in all cycles. Infection episodes occurred in 41 out of 168 cycles (25%) in the control group compared to 7 out of 172 (4%) in th e G-CSF arm. Complete response was achieved in 12 out of 22 (54%) in t he control group compared to 16 out 20 (80%) in the patients who recei ved G-CSF. Toxicity secondary to G-CSF was mild. G-CSF can be administ ered safely to patients with DLCL and results in improved hematologic recovery after intensive chemotherapy. Full dose chemotherapy can be a dministered on time, resulting in an increase in the overall response and less infectious complications when compared to the control group. We feel that G-CSF should be introduced in clinical trials with more i ntensive chemotherapy for patients with DLCL in order to improve the t ype and probable duration of response.