title: Effect of priming with granulocyte colony-stimulating factor on the outcome of chemotherapy for acute myeloid leukemia.
abstract: BACKGROUND
  Sensitization of leukemic cells with hematopoietic growth factors may enhance the cytotoxicity of chemotherapy in acute myeloid leukemia (AML).
  
  
  METHODS
  In a multicenter randomized trial, we assigned patients (age range, 18 to 60 years) with newly diagnosed AML to receive cytarabine plus idarubicin (cycle 1) and cytarabine plus amsacrin (cycle 2) with granulocyte colony-stimulating factor (G-CSF) (321 patients) or without G-CSF (319). G-CSF was given concurrently with chemotherapy only. Idarubicin and amsacrin were given at the end of a cycle to allow the cell-cycle-dependent cytotoxicity of cytarabine in the context of G-CSF to have a greater effect. The effect of G-CSF on disease-free survival was assessed in all patients and in cytogenetically distinct prognostic subgroups.
  
  
  RESULTS
  After induction chemotherapy, the rates of response were not significantly different in the two groups. After a median follow-up of 55 months, patients in complete remission after induction chemotherapy plus G-CSF had a higher rate of disease-free survival than patients who did not receive G-CSF (42 percent vs. 33 percent at four years, P=0.02), owing to a reduced probability of relapse (relative risk, 0.77; 95 percent confidence interval, 0.61 to 0.99; P=0.04). G-CSF did not significantly improve overall survival (P=0.16). Although G-CSF did not improve the outcome in the subgroup with an unfavorable prognosis, the 72 percent of patients with standard-risk AML benefited from G-CSF therapy (overall survival at four years, 45 percent, as compared with 35 percent in the group that did not receive G-CSF [relative risk of death, 0.75; 95 percent confidence interval, 0.59 to 0.95; P=0.02]; disease-free survival, 45 percent vs. 33 percent [relative risk, 0.70]; 95 percent confidence interval, 0.55 to 0.90; P=0.006).
  
  
  CONCLUSIONS
  Sensitization of leukemic cells with growth factors is a clinically applicable means of enhancing the efficacy of chemotherapy in patients with AML.
authors.affiliation: Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands. b.lowenberg@erasmusmc.nl
authors.forename: Bob
authors.initials: B
authors.lastname: Löwenberg
authors.forename: Wim
authors.initials: W
authors.lastname: van Putten
authors.forename: Matthias
authors.initials: M
authors.lastname: Theobald
authors.forename: Jurg
authors.initials: J
authors.lastname: Gmür
authors.forename: Leo
authors.initials: L
authors.lastname: Verdonck
authors.forename: Pieter
authors.initials: P
authors.lastname: Sonneveld
authors.forename: Martin
authors.initials: M
authors.lastname: Fey
authors.forename: Harry
authors.initials: H
authors.lastname: Schouten
authors.forename: Georgine
authors.initials: G
authors.lastname: de Greef
authors.forename: Augustin
authors.initials: A
authors.lastname: Ferrant
authors.forename: Tibor
authors.initials: T
authors.lastname: Kovacsovics
authors.forename: Alois
authors.initials: A
authors.lastname: Gratwohl
authors.forename: Simon
authors.initials: S
authors.lastname: Daenen
authors.forename: Peter
authors.initials: P
authors.lastname: Huijgens
authors.forename: Marc
authors.initials: M
authors.lastname: Boogaerts
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003561:Cytarabine / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D019650:Hematopoietic Stem Cell Mobilization; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D016019:Survival Analysis
chemical_list: D003561:Cytarabine; D016179:Granulocyte Colony-Stimulating Factor; D015255:Idarubicin