title: Granulocyte colony-stimulating factor (G-CSF, filgrastim) after or during an intensive remission induction therapy for adult acute lymphoblastic leukaemia: effects, role of patient pretreatment characteristics, and costs.
abstract: An early intensive anthracycline therapy can improve therapeutic outcome in adult acute lymphoblastic leukaemia (ALL) but is usually associated with marked myelosuppressive effects and significant morbidity by infections. To reduce this risk, we employed granulocyte colony-stimulating factor (G-CSF, filgrastim 5 microg/kg/d) as an adjunct to a myelotoxic, 14-day long induction regimen with idarubicin-vincristine-L-asparaginase-prednisone (IVAP). Owing to changes in study design, patients received 'late' (n = 28) or 'early' (n = 37) G-CSF from days 15 or 4 of IVAP, respectively, until resolution of severe neutropenia. Study endpoints included time to recovery from neutropenic nadir, duration of neutropenia <0.5 x 10(9)/l, incidence of infectious complications, assessment of variables affecting G-CSF response, clinical outcome and costs. Sixty-five consecutive cases were evaluable. Patients in early G-CSF group recovered significantly faster from the neutropenic nadir (p < 0.002), contracted less infectious complications (p = 0.007), and required less intravenous antibiotic (p = 0.008) and antifungal (p = 0.002) medications. Although these reductions did not compensate for the increased G-CSF treatment cost, the overall supportive care cost was not significantly increased by early G-CSF. Interestingly, T-ALL phenotype (p = 0.02) and higher neutrophil presentation count (p = 0.03) were associated with a shorter neutropenic course even with late G-CSF. Early G-CSF may be a valid approach to mitigate chemotherapy-induced neutropenia of IVAP and other similarly myelosuppressive adult ALL regimens.
authors.affiliation: Ospedali Riuniti di Bergamo, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Bassan
authors.forename: T
authors.initials: T
authors.lastname: Lerede
authors.forename: E
authors.initials: E
authors.lastname: Di Bona
authors.forename: G
authors.initials: G
authors.lastname: Rossi
authors.forename: E
authors.initials: E
authors.lastname: Pogliani
authors.forename: A
authors.initials: A
authors.lastname: Rambaldi
authors.forename: M
authors.initials: M
authors.lastname: Buelli
authors.forename: P
authors.initials: P
authors.lastname: Viero
authors.forename: F
authors.initials: F
authors.lastname: Rodeghiero
authors.forename: T
authors.initials: T
authors.lastname: Izzi
authors.forename: G
authors.initials: G
authors.lastname: Corneo
authors.forename: T
authors.initials: T
authors.lastname: Barbui
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001215:Asparaginase / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000191:economics; D011239:Prednisolone / Q000008:administration & dosage; D011446:Prospective Studies; D011994:Recombinant Proteins; D012074:Remission Induction / Q000379:methods; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D014750:Vincristine; D011239:Prednisolone; D001215:Asparaginase; D000069585:Filgrastim; D015255:Idarubicin