GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR IN PATIENTS WITH NEUTROPENIC FEVER IS POTENT AFTER LOW-RISK BUT NOT AFTER HIGH-RISK NEUTROPENIC CHEMOTHERAPY REGIMENS - RESULTS OF A RANDOMIZED PHASE-III TRIAL
A. Ravaud et al., GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR IN PATIENTS WITH NEUTROPENIC FEVER IS POTENT AFTER LOW-RISK BUT NOT AFTER HIGH-RISK NEUTROPENIC CHEMOTHERAPY REGIMENS - RESULTS OF A RANDOMIZED PHASE-III TRIAL, Journal of clinical oncology, 16(9), 1998, pp. 2930-2936
Purpose: A randomized unblinded phase III trial was designed to determ
ine the ability of granulocyte-macrophage colony-stimulating factor (G
M-CSF) to accelerate recovery from febrile neutropenia induced by chem
otherapy. Patients and Methods: A fetal of 68 patients with febrile ne
utropenia following chemotherapy defined as axillary temperature great
er than 38 degrees C and absolute neutrophil count (ANC) less than 1 x
10(9)/L were included. After stratification for high- and low-risk ch
emo therapy to induce febrile neutropenia, treatment was randomized be
tween GM-CSF at 5 mu g/kg/d or control, both being associated with ant
ibiotics. Results: GM-CSF significantly reduced the median duration of
neutropenia from 6 to 3 days for ANC less than 1 x 10(9)/L (P < .001)
and from 4 to 3 days for ANC less than 0.5 x 10(9)/L(P = .024), days
of hospitalization required for febrile neutropenia, and duration of a
ntibiotics during hospitalization. The greatest benefit with GM-CSF ap
peared for patients who had received low-risk chemotherapy, for which
the median duration of ANC less than 1 x 10(9)/L. was reduced from 7 t
o 2.5 days (P < .001) and from 4 to 2 days for ANC less than 0.5 x 10(
9)/L (P = .0011), the duration of hospitalization during the study fro
m 7 to 4 days (P = .003), and the duration on antibiotics during hospi
talization from 7 to 3.5 days (P < .001). A multivariate analysis, usi
ng Cox regression, showed that variables predictive for recovery from
neutropenia were GM-CSF (P = .0010) and time interval between the firs
t day of chemotherapy and randomization (P = .030). There was no benef
it for GM CSF when high-risk chemotherapy was considered. Conclusion:
GM-CSF significantly shortened duration of neutropenia, duration of ne
utropenic fever-related hospitalization, and duration on antibiotics d
uring hospitalization when febrile neutrapenia occurred after low-risk
chemotherapy, but not high-risk chemotherapy. J Clin Oncol 16:2930-29
36, (C) 1998 by American Society of Clinical Oncology.