ENHANCED MYELOTOXICITY DUE TO GRANULOCYTE-COLONY-STIMULATING FACTOR ADMINISTRATION UNTIL 48 HOURS BEFORE THE NEXT CHEMOTHERAPY COURSE IN PATIENTS WITH SMALL-CELL LUNG-CARCINOMA

Purpose: To evaluate the impact of granulocyte colony-stimulating fact or (G-CSF) priming on peripheral-blood cell counts during standard-dos e chemotherapy. Patients and Methods: Twelve patients with relapsed sm all-cell lung carcinoma (SCLC) were treated with two chemotherapy cour ses. Six patients received G-CSF priming only before the first course (group A) and the other six patients only before the second course (gr oup B). Each patient served as his own control. patients were treated with cyclophosphamide, epirubicin, and etoposide (CEE), or with vincri stine, ifosfamide, mesna, and carboplatin (VIMP) every 4 weeks. G-CSF was administered subcutaneously 5 mu g/kg/d for 6 days until 48 hours before the first or second chemotherapy course. Results: Priming cause d a lowering of the WBC nadir, with a median value of 0.95 x 10(9)/L(P = .004), and of absolute neutrophil nadir, with a median value of 0.4 8 x 10(9)/L(P = .03), There was a trend for a lower platelet (PLT) nad ir after G-CSF priming (P = .09). G-CSF priming resulted in a prolonge d duration of WBC count less than 3.0 x 10(9)/L of +4.25 days (P = .04 ), and of WBC count less than 3.0 x 10(9)/L of +0.50 days (B = .03). T he duration of neutropenia less than 0.5 x 10(9)/L seemed longer in pr imed courses (+3.75 days, P = .18). The duration of PLT counts less th an 100 x 10(9)/L was prolonged by 1.5 days (P = .04). Hemoglobin (Hgb) levels were not influenced by G-CSF priming. Conclusion: G-CSF admini stration until 48 hours before the next chemotherapy course increases chemotherapy-associated leukocytopenia and thrombocytopenia. This may be of special concern when G-CSF is administered during doss densified chemotherapy. J Clin Oncol 16: 2708-2714. (C) 1998 by American Societ y of Clinical Oncology.