EFFECT OF RECOMBINANT HUMAN GRANULOCYTE-MACROPHAGE COLONY-STIMULATINGFACTOR (GM-CSF) ON CHEMOTHERAPY-INDUCED MYELOSUPPRESSION IN PATIENTS WITH CHRONIC LYMPHOCYTIC-LEUKEMIA - A CROSSOVER STUDY

Patients with advanced, refractory chronic lymphocytic leukemia (CLL) have an high morbidity and mortality from infections following chemoth erapy-induced myelosuppression. A crossover study on the prophylactic effect of GM-CSF therapy on neutropenia was carried out in 12 patients with advanced CLL. The patients received GM-CSF in association with e very second cycle of COP (cyclophosphamide, vincristine, prednisone) c hemotherapy. A total of 40 COP cycles were analyzed. Blood neutrophil levels were significantly higher two to three weeks after the first CO P cycle followed by GM-CSF (medians 2.24 and 5.47 x 10(9)/l) when comp ared to the first cycle without GM-CSF support (0.59 and 0.75 x 10(9)/ l; p <0.0195 and <0.002, respectively). In the next two cycles the sam e tendency persisted, although the difference was not statistically si gnificant. There were no significant differences in the number of febr ile days, days on intravenous antibiotics, hospitalization days, or th e number of red blood cell transfusions. Mortality during COP treatmen t was 8%. In conclusion, GM-CSF efficiently ameliorates chemotherapy-i nduced neutropenia in CLL patients with a poor bone marrow reserve due to advanced disease.