Perspective of rhGM-CSF in the treatment of neutropenic infections and aggressive lymphomas.
Non-Hodgkin lymphomas (NHL) of intermediate and high-grade malignancy respond well to doxorubicin-containing regimens, but long-term survival does not exceed 30% in large studies with long-term follow-up. Any attempt to improve this somehow disappointing result by adding more drugs, increasing doses or shortening time intervals of chemotherapy have so far failed in randomized settings. Even autologous bone marrow transplantation (ABMT) could not improve long-term survival when applied in first remission of the disease. Prophylactic use of hematopoietic growth factors in the chemotherapy of aggressive NHL did prevent neutropenia and positively influenced the occurrence of infectious complications, and also led to an increase of dose intensity (DI) by 15% but this did not affect survival. In contrast, a retrospective analysis of an NHL study showed that a high DI may in fact be deleterious rather than beneficial. Thus the prophylactic use of hematopoietic growth factors still has to be considered experimental in the chemotherapy of NHL and should be studied in controlled settings like the one proposed here.
Med. Dept. III, Klinikum Grosshadern, Munich, Germany.
H H
HH
Gerhartz
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D016026:Bone Marrow Transplantation; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D008223:Lymphoma / Q000628:therapy*; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D009503:Neutropenia / Q000139:chemically induced / Q000209:etiology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000627:therapeutic use; D015996:Survival Rate
D011994:Recombinant Proteins; D016178:Granulocyte-Macrophage Colony-Stimulating Factor