title: Hematopoietic protection by dexamethasone or granulocyte-macrophage colony-stimulating factor (GM-CSF) in patients treated with carboplatin and ifosfamide.
abstract: Based on preclinical studies, the authors undertook a pilot study to determine the hematologic and biologic effects of pretreatment with dexamethasone (Dex) or granulocyte-macrophage colony-stimulating factor (GM-CSF) in patients receiving carboplatin and ifosfamide. Patients (n = 28) with metastatic solid tumors were randomized to receive pretreatment with Dex or GM-CSF or no pretreatment prior to courses 1 or 2 of carboplatin and ifosfamide. No alteration in dose of chemotherapy was allowed between course 1 and 2. Alterations of hematologic and nonhematologic toxicity and selected biologic parameters were compared between courses 1 and 2. Patients without any pretreatment demonstrated worsening hematologic toxicity in course 2 compared to course 1. In contrast, Dex pretreatment reduced hematopoietic toxicity and improved the absolute granulocyte count (AGC) and platelet count recovery times. For example, course 1 versus course 2 (with Dex pretreatment): AGC nadir (mm3) 153 versus 549 (p = 0.07), days AGC <500/mm3 7.8 versus 4.0 (p = 0.10), days to AGC recovery >1,500/mm3, 26 versus 22 (p = 0.034). Overall comparison between all five cohorts by analyses of variance demonstrated that intervention with Dex improved multiple hematopoietic toxicities, including AGC nadir (p = 0.015), and recovery times to AGC >1,500/mm3 (p = 0.07) and platelet count to >100,000/mm3 (p = 0.05). GM-CSF pretreatment did not worsen hematopoietic parameters after course 2 compared to course 1. Expected biologic effects of Dex and GM-CSF treatment were observed. Patients demonstrated an overall response rate of 32%, 1 complete response, and 8 partial responses. In patients with cancer, pretreatment with Dex or GM-CSF may significantly decrease the hematopoietic toxicity of chemotherapeutic agents.
authors.affiliation: University of Alabama at Birmingham Comprehensive Cancer Center, 35294-3300, USA.
authors.forename: John
authors.initials: J
authors.lastname: Rinehart
authors.forename: Lisa
authors.initials: L
authors.lastname: Keville
authors.forename: Jeff
authors.initials: J
authors.lastname: Neidhart
authors.forename: Lucas
authors.initials: L
authors.lastname: Wong
authors.forename: Lucio
authors.initials: L
authors.lastname: DiNunno
authors.forename: Patricia
authors.initials: P
authors.lastname: Kinney
authors.forename: Marie
authors.initials: M
authors.lastname: Aberle
authors.forename: Laura
authors.initials: L
authors.lastname: Tadlock
authors.forename: Gretchen
authors.initials: G
authors.lastname: Cloud
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D005434:Flow Cytometry; D005455:Fluorescent Antibody Technique; D005938:Glucocorticoids / Q000627:therapeutic use*; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use*; D006397:Hematinics / Q000627:therapeutic use*; D006410:Hematopoiesis / Q000187:drug effects*; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage / Q000009:adverse effects; D016131:Lymphocyte Subsets; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects
chemical_list: D005938:Glucocorticoids; D006397:Hematinics; D003907:Dexamethasone; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D016190:Carboplatin; D007069:Ifosfamide