RECOMBINANT HUMAN GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR AFTER CHEMOTHERAPY IN ELDERLY PATIENTS WITH PRIMARY ACUTE MYELOGENOUS LEUKEMIA

Standard intensive induction chemotherapy is poorly tolerated by elder ly patients with acute myelogenous leukemia (AML). To reduce critical neutropenia after chemotherapy, we administered recombinant human gran ulocyte-macrophage colony-stimulating factor (CM-CSF) to 15 newly diag nosed elderly patients, who received full-dose induction chemotherapy with daunomycin 45 mg/m(2) per day for 3 days, cytarabine 100 mg/m(2) per day for 7 days, and etoposide 75 mg/m(2) per day for 4 days. GM-CS F 250 mu g/m(2) per day was given after completion of chemotherapy. Se ven patients achieved complete remission; and the overall rate of comp lete remission was 53%. Median survival was 10 months overall, 13 mont hs for the 8 patients who achieved complete remission, and only 2 mont hs for those without remission. Fourteen of the 15 patients experience d relapses and died during follow-up. One patient remained in complete remission 30 months after the initial diagnosis. Compared with a hist orical group of similar age and treatment protocol, there was no stati stically significant improvement in remission rate or impact on overal l survival. Biologic differences in leukemias in older patients compar ed with those in younger patients explain why GM-CSF failed to improve treatment outcome.