GRANULOCYTIC COLONY-STIMULATING FACTORS (G-CSF AND GM-CSF) IN THE TREATMENT OF ADULT ACUTE MYELOID-LEUKEMIA

Large randomized trials have shown that granulocytic colony-stimulatin g factors (G-CSF and GM-CSF) may be interesting in vivo in promoting n eutrophil recovery after high-dose myelosuppressive therapy in some cl inical settings. However, any beneficial effect on survival was not ye t demonstrated. Granulocytic CSFs act as growth and viability factors on myeloid leukemic cells and their use in acute myeloid leukemias (AM L) is theorically not without risk. Paradoxically, these CSFs will may be be usefull in the future as a part of AML treatment. First, the hig h early mortality rate in elderly AML patients after intensive chemoth erapy should allow a demonstration of a CSF-induced improvement of sur vival. Secondly, GM-CSF should increase the efficacy of cell cycle dep endent cytotoxic drugs based on recruitment of quiescent leukemic cell s. Third, granulocytic CSFs should be used to induce programmed cell d eath in myeloid leukemic cells.