title: Administration of recombinant human granulocyte-macrophage colony-stimulating factor after autologous bone marrow transplantation in children with acute myelogenous leukemia: a note of caution.
abstract: A series of 22 consecutive pediatric patients undergoing ABMT for treatment of primary AML was reviewed in an efficacy analysis of recombinant human granulocytemacrophage colony-stimulating factor (rhGM-CSF). Treatment with at least two cycles of chemotherapy and a standard conditioning regimen of busulfan and cyclophosphamide preceded the marrow infusion. Twelve patients who underwent transplants between 1992 and 1994 received 5.5 micrograms/kg/day rhGM-CSF as part of their transplant protocol. They were compared with 10 patients who underwent transplants between 1989 and 1991 but did not receive rhGM-CSF. Despite containing a significantly higher proportion of patients in first clinical remission at the time of the transplant, the rhGM-CSF-treated group had a significantly higher relapse and poorer overall survival rate after ABMT than the untreated group (36 vs 90%). The rhGM-CSF-treated group tended to have more rapid neutrophil engraftment and shorter hospital stays; however, neither of these trends was statistically significant. To properly determine the role of rhGM-CSF in the survival of pediatric patients undergoing ABMT for treatment of AML, a prospective randomized trial is desirable. Until these data are available, the current analysis suggests that particular caution is indicated with the use of this drug in this group of patients.
authors.affiliation: Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Calderwood
authors.forename: J J
authors.initials: JJ
authors.lastname: Doyle
authors.forename: J K
authors.initials: JK
authors.lastname: Hitzler
authors.forename: E F
authors.initials: EF
authors.lastname: Saunders
authors.forename: M H
authors.initials: MH
authors.lastname: Freedman
mesh_terms: D000208:Acute Disease; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007951:Leukemia, Myeloid / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015993:Life Tables; D008297:Male; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use*; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D016178:Granulocyte-Macrophage Colony-Stimulating Factor