GRANULOCYTE-COLONY-STIMULATING FACTOR (G-CSF, FILGRASTIM) AFTER OR DURING AN INTENSIVE REMISSION INDUCTION THERAPY FOR ADULT ACUTE LYMPHOBLASTIC-LEUKEMIA - EFFECTS, ROLE OF PATIENT PRETREATMENT CHARACTERISTICS, AND COSTS

An early intensive anthracycline therapy can improve therapeutic outco me in adult acute lymphoblastic leukaemia (ALL) but is usually associa ted with marked myelosuppressive effects and significant morbidity by infections. To reduce this risk, we employed granulocyte colony-stimul ating factor (G-CSF, filgrastim 5 mu g/kg/d) as an adjunct to a myelot oxic, 14-day long induction regimen with idarubicin-vincristine-L-aspa raginase-prednisone (IVAP). Owing to changes in study design, patients received 'late' (n = 28) or 'early' (n = 37) G-CSF from days 15 or 4 of IVAP, respectively, until resolution of severe neutropenia. Study e ndpoints included time to recovery from neutropenic nadir, duration of neutropenia <0.5 x 10(9)/l, incidence of infectious complications, as sessment of variables affecting G-CSF response, clinical outcome and c osts. Sixty-five consecutive cases were evaluable. Patients in early G -CSF group recovered significantly faster from the neutropenic nadir ( p < 0.002), contracted less infectious complications (p = 0.007), and required less intravenous antibiotic (p = 0.008) and antifungal (p = 0 .002) medications. Although these reductions did not compensate for th e increased G-CSF treatment cost, the overall supportive care cost was not significantly increased by early G-CSF. Interestingly, T-ALL phen otype (p = 0.02) and higher neutrophil presentation count (p = 0.03) w ere associated with a shorter neutropenic course even with late G-CSF. Early G-CSF may be a valid approach to mitigate chemotherapy-induced neutropenia of IVAP and other similarly myelosuppressive adult ALL reg imens.