title: Phase I/II trial of recombinant human granulocyte-macrophage colony-stimulating factor following allogeneic bone marrow transplantation.
abstract: Forty-seven patients with hematologic neoplasia received recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) by daily 2-hour infusion following allogeneic bone marrow transplantation from HLA-identical sibling donors in a phase I-II dose-escalation trial. Dose levels ranged from 30 to 500 micrograms/m2/d. At doses at or below 250 micrograms/m2/d, toxicity felt to be caused by rhGM-CSF was negligible. However, three of five patients treated with 500 micrograms/m2/d had unacceptable side effects caused by rhGM-CSF. Two different graft-versus-host disease (GVHD) prophylactic regimens were administered. Twenty-seven evaluable patients were administered regimens that did not contain methotrexate (MTX) (Group I) and reached an absolute neutrophil count of 1,000/microL by a median of day 14. In contrast, 18 patients who received GVHD prophylactic regimens containing MTX (Group II) reached an absolute neutrophil count of 1,000/microL on a median of day 20. Patients in Group I had fewer febrile days and, of those discharged, had shorter initial hospitalizations than patients in Group II. The overall incidence of severe acute GVHD (grade 2 or greater) in the rhGM-CSF-treated patients was 28% and was similar to that in historical "good risk" patients who did not receive rhGM-CSF. These preliminary data suggest rhGM-CSF is unlikely to exacerbate GVHD in HLA-identical sibling donor transplants and indicate the need for randomized trials of rhGM-CSF in allogeneic marrow transplant patients.
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: J
authors.initials: J
authors.lastname: Nemunaitis
authors.forename: C D
authors.initials: CD
authors.lastname: Buckner
authors.forename: F R
authors.initials: FR
authors.lastname: Appelbaum
authors.forename: C S
authors.initials: CS
authors.lastname: Higano
authors.forename: M
authors.initials: M
authors.lastname: Mori
authors.forename: J
authors.initials: J
authors.lastname: Bianco
authors.forename: C
authors.initials: C
authors.lastname: Epstein
authors.forename: J
authors.initials: J
authors.lastname: Lipani
authors.forename: J
authors.initials: J
authors.lastname: Hansen
authors.forename: R
authors.initials: R
authors.lastname: Storb
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003524:Cyclosporins / Q000627:therapeutic use; D004341:Drug Evaluation; D005260:Female; D005334:Fever / Q000517:prevention & control; D006086:Graft vs Host Disease / Q000517:prevention & control; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000009:adverse effects / Q000627:therapeutic use*; D006689:Hodgkin Disease / Q000628:therapy; D006801:Humans; D017053:Infection Control; D007938:Leukemia / Q000628:therapy*; D008223:Lymphoma / Q000628:therapy*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D003524:Cyclosporins; D011994:Recombinant Proteins; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D011241:Prednisone; D008727:Methotrexate