Publication Date:
2004-11-16
Description:
Background: Treatment for acute myelogenous leukemia (AML) is one of the most intensive treatment modalities in pediatric oncology. Infection-related mortality is particularly high among these patients during chemotherapy-induced neutropenia. Granulocyte colony-stimulating factor (G-CSF) expands the circulating pool of neutrophils by stimulating proliferation and maturation of myeloid progenitor cells. Although G-CSF is widely used for the prevention of infectious complications in cancer patients, no larger randomized study has evaluated the effect of G-CSF in pediatric cancer patients undergoing treatment for AML. Patients and Methods: The impact of G-CSF on hematopoetic recovery, infectious complications and five-year event-free survival (5-EFS) was prospectively evaluated in the multicenter clinical trial AML-BFM 98. Patients (inclusion criteria: primary diagnosis of AML, age 0–18 years) were randomized to receive or not to receive G-CSF (5 μg/kg/day) after induction 1 (cytarabine, idarubicin, etoposide; AIE) and induction 2 (high-dose cytarabine and mitoxantrone; HAM). Patients who had more than 5% blasts in the bone marrow on day 15 were excluded from randomization. Patients with Down Syndrome were included in the clinical trial, but received only 60% of idarubicin in induction 1 and no second induction (HAM). Results: Between July 1998 and June 2003, 546 patients entered the clinical trial AML-BFM 98 (Down Syndome: n=45). Three-hundred-and-twenty-seven patients were eligible for randomization. Hundred-fifty eight of these patients were randomized to receive G-CSF, and 169 patients not to receive G-CSF. Both groups did not differ in their clinical characteristics. The G-CSF group had a significantly shorter duration of neutropenia (ANC
Print ISSN:
0006-4971
Electronic ISSN:
1528-0020
Topics:
Biology
,
Medicine
