HIGH-DOSE CYTARABINE-CONTAINING CHEMOTHERAPY WITH OR WITHOUT GRANULOCYTE-COLONY-STIMULATING FACTOR FOR CHILDREN WITH ACUTE-LEUKEMIA

We sought to determine the role of granulocyte colony-stimulating fact or (G-CSF) as an adjunct therapy in high-dose cytarabine-containing ch emotherapy (HD C/T) for children with acute leukemia. Seventeen patien ts, aged 9 months to 18 years old, 8 ALL and 9 AML, were treated with cytarabine (Ara-C) 1 g/m(2) q12h for 8 doses with mitoxantrone, idarub icin, VP-16, or asparaginase. A total of 71 courses of Ho C/T was give n. G-CSF was not used in 14 courses (Group A). Prophylactic G CSF was given in 57 courses (Group B) as 200 mu g/m(2)/d SC started one day af ter the completion of HD C/T and continued until the neutrophil recove ry was maintained. The incidences of sepsis per course in Group A and Group B were 35.7% (5/14) and 40.4% (23/57), respectively. While 2 pat ients in Group A died of sepsis or pneumonia, none in Group B died. Th e mortality and delay in chemotherapy were fewer in Group B (P = 0.037 and 0.0006, respectively, Fisher exact test). There was a shorter ave rage number of days of neutrophil <500/cumm, antibiotic usage, fever, and hospital stay in Group B (11, 8, 5, 17 days in Group B vs. 21, 17, 10, 37 days in Group A; P = 0.0001, log-rank test; 0.0005, 0.0023, 0. 0001, Wilcoxon rank sum test, respectively). The incidence of neutrope nic fever was lower in Group B, but the difference did not reach stati stical significance (P = 0.06, Fisher exact test). We conclude that G- CSF as an adjunct therapy in HD C/T is effective in reducing mortality , days of neutropenia, antibiotic usage, fever, hospital stay, and fre quency of delay in chemotherapy. The efficacy of this treatment approa ch requires further testing in a randomized, controlled trial. (C) 199 8 Wiley-Liss, Inc.