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Intensive chemotherapy with mitoxantrone and high-dose cytosine arabinoside
followed by granulocyte-macrophage colony-stimulating factor in the
treatment of patients with acute lymphocytic leukemia
HM Kantarjian, EH Estey, S O'Brien, E Anaissie, M Beran, MB Rios, MJ Keating and J Gutterman
Department of Hematology, University of Texas M.D. Anderson Cancer Center,
Houston 77030.
Thirty-four adults with refractory acute lymphocytic leukemia received
salvage therapy with mitoxantrone 5 mg/m2 intravenously over 1 hour daily
for 5 days and cytosine arabinoside (ara-C) 3 g/m2 intravenously over 2
hours every 12 hours for six doses, followed by granulocyte- macrophage
colony-stimulating factor (GM-CSF) 125 microgram/m2 intravenously over 4
hours daily until recovery of granulocytes above 2.0 x 10(3)/microL. Their
outcome was compared with 29 prognostically similar historical control
patients treated with the identical chemotherapy without GM-CSF. Overall,
the complete response rates were similar in the treatment and control
groups (13 of 34 [38%] v 11 of 29 [38%]). There was a trend for less
remission induction mortality in the GM-CSF-treated patients (2 of 34 [6%]
v 6 of 29 [21%]; P = .08), but, conversely, a higher rate of resistant
disease (19 of 34 [56%] v 10 of 29 [34%]; P = .09). Recovery of granulocyte
counts above 500/microL was significantly faster in the GM-CSF-treated
group (25 days v 33 days; P less than .01), but there was no reduction in
the incidence of febrile episodes (91% v 93%) or of documented infections
(59% v 59%). Survival was prolonged in the GM-CSF-treated patients but was
not of clinical relevance (31 v 20 weeks; P = .05). In summary, the
addition of GM-CSF to intensive chemotherapy in refractory adult ALL was
associated with a reduction in the remission induction mortality, probably
secondary to a shorter duration of granulocytopenia, but not with an
improvement in complete response rates.
Volume 79,
Issue 4,
pp. 876-881,
02/15/1992
Copyright © 1992 by The American Society of Hematology
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