Human urinary macrophage colony-stimulating factor reduces the incidence and duration of febrile neutropenia and shortens the period required to finish three courses of intensive consolidation therapy in acute myeloid leukemia: a double-blind controlled study.
OBJECTIVE
To determine whether macrophage colony-stimulating factor (M-CSF) reduces the incidence and duration of febrile neutropenia during three courses of intensive consolidation therapy and whether it shortens time to complete consolidation therapy.


METHODS
In 198 adult patients with acute myeloid leukemia (AML) in complete remission (CR), M-CSF (8 x 10(6) U/d) or placebo was administered from 1 day after the end of each consolidation chemotherapy for 14 days.


RESULTS
The duration and incidence of febrile neutropenia was significantly reduced by 34% (P = .00285) and 17% (P = .02065), respectively, in 88 assessable patients in the M-CSF group compared with those in 94 assessable patients in the placebo group. Patients in the M-CSF group had 565 days and 133 episodes of febrile neutropenia during 7,901 days at risk, while patients in the placebo group had 977 days and 185 episodes during 9,077 days at risk. The median period required to finish the three courses of consolidation therapy was 93 days in the M-CSF group, which was significantly shorter than 110 days in placebo group (P = .0050). In the M-CSF group, the recovery of neutrophils and platelets was significantly faster (P = .0348 and P = 0.0364, respectively), the administration of systemic antimicrobial agents tended to be less (P = .0839), and the frequency of platelet transfusion (P = .0259) and the total volume of transfused platelets (P = .0292) were significantly less. However, there was no significant difference in the disease-free survival.


CONCLUSIONS
M-CSF significantly reduced the incidence and duration of febrile neutropenia during the intensive consolidation therapy, and shortened the time to complete consolidation chemotherapy in AML.
Ohno
R
R
Department of Medicine, Hamamatsu University School of Medicine, Japan. ohnoryu@hama-med.ac.jp
Miyawaki
S
S
Hatake
K
K
Kuriyama
K
K
Saito
K
K
Kanamaru
A
A
Kobayashi
T
T
Kodera
Y
Y
Nishikawa
K
K
Matsuda
S
S
Yamada
O
O
Omoto
E
E
Takeyama
H
H
Tsukuda
K
K
Asou
N
N
Tanimoto
M
M
Shiozaki
H
H
Tomonaga
M
M
Masaoka
T
T
Miura
Y
Y
Takaku
F
F
Ohashi
Y
Y
Motoyoshi
K
K
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005334:Fever / Q000139:chemically induced / Q000628:therapy*; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D007951:Leukemia, Myeloid / Q000097:blood / Q000188:drug therapy*; D007958:Leukocyte Count; D016173:Macrophage Colony-Stimulating Factor / Q000009:adverse effects / Q000627:therapeutic use* / Q000652:urine; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000097:blood / Q000139:chemically induced / Q000628:therapy*; D009504:Neutrophils; D010976:Platelet Count; D013997:Time Factors
D016179:Granulocyte Colony-Stimulating Factor; D016173:Macrophage Colony-Stimulating Factor